Healthcare Provider Details

I. General information

NPI: 1639874233
Provider Name (Legal Business Name): BONNIE FENOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N MCCLINTOCK DR STE 4
CHANDLER AZ
85226-3711
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax: 480-464-2338
Mailing address:
  • Phone: 916-576-7900
  • Fax: 480-565-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21969
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC21969
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: