Bonnie Rose Bury-Blattman, LPC
Individual provider Active NPI Professional Counselor · Lindale, TX
NPI 1669937041 · NPPES record last updated Apr 8, 2026
Key facts
- NPI
- 1669937041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 80342 (TX)
- Practice address
- 2808 S Main St Ste I
Lindale, TX 75771-7854 - Phone
- (903) 565-9022
- Fax
- (214) 224-0731
- NPI assigned
- Feb 9, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231207000238 | TX | Practitioner - Mental Health Counselor | 4486003126 |
Reassigns benefits to 3 organizations Practice locations: Tyler, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11745 | TX | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mt Enterprise Community Health Clinic | Current |
Accepting new patients | |
| Thrive Counseling and Life Coaching, PLLC | Multi-Specialty | Current |
Accepting new patients |
| Andrews Center - HCS | Current |
Accepting new patients | |
| Mt Enterprise Community Health Clinic | Multi-Specialty | Current | Accepting new patients |
| Andrews Center | Multi-Specialty | Current | Accepting new patients |
| Mt Enterprise Community Health Clinic | Current |
Accepting new patients | |
| Andrews Center -Pinkerton | Multi-Specialty | Current |
Accepting new patients |
| Andrews Center - Elliott St | Past | Accepting new patients |
Locations
1738 Elliot Dr
Canton, TX 75103
Phone (903) 597-5067
1115 US Highway 259 S
Henderson, TX 75654
Phone (903) 392-8203
300 N High St
Henderson, TX 75652
Phone (903) 392-8203
4002 S Loop 256
Ste K
Palestine, TX 75801
Phone (903) 723-0600
1722 W Front St
Tyler, TX 75702
Phone (903) 593-4004
2323 W Front St
Tyler, TX 75702
Phone (903) 535-7355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 80342 | TX | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11745 | TX |
Addresses
Primary practice location
2808 S Main St Ste I
Lindale, TX 75771-7854
Mailing address
10116 Sparks Dr
Tyler, TX 75704-3935
Phone (903) 565-9022
Other practice location 1
300 N High St
Henderson, TX 75652-5908
Phone (903) 392-8203
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 396545103 | Medicaid | TX |
Other providers in Lindale, TX
- Raymond J Broadbent
- Bronze Star Home Health Care LLC
- Melita Lang Brooks
- Brookshire Grocery Company
- Camden Kae Brown
- Latoya N Bush
- Kimberly Elaine Butler
- Cannery Pharmacy Services LLC
- Cannery Pharmacy Services LLC
- Allyson Elaine Carter
All providers in Lindale, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.