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NPI Code Detail

MEDICARE: MRS. BONNIE N EARLY MFT

MEDICARE: MRS. BONNIE N EARLY MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 50243CA

General Provider Information

NPI Number : 1780877167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BONNIE N EARLY MFT
Provider Business Mailing Address
First Line : 2121 NATOMAS CROSSING DR
Second Line : SUITE 200-337
City : SACRAMENTO
State : CA
Zip : 95834-3847
Country : US
Telephone Number : 916-833-5171
Fax Number :
Provider Business Practice Location Address
First Line : 180 PROMENADE CIR
Second Line : SUITE 300
City : SACRAMENTO
State : CA
Zip : 95834-2939
Country : US
Telephone Number : 916-833-5171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 10/15/2015

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