Basic Information
| Provider Information | |||||||||
| NPI: | 1720389968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARAKAT-SMITH | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1997 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380193630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014768967 | ||||||||
| FaxNumber: | 9017462498 | ||||||||
| Practice Location | |||||||||
| Address1: | 5281 NAVY RD | ||||||||
| Address2: | |||||||||
| City: | MILLINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380532535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018730305 | ||||||||
| FaxNumber: | 9018730306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PE0000001693 | TN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.