Healthcare Provider Details

I. General information

NPI: 1568308765
Provider Name (Legal Business Name): UNBOUND THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 W 16TH PL
YUMA AZ
85364-5141
US

IV. Provider business mailing address

2229 W 16TH PL
YUMA AZ
85364-5141
US

V. Phone/Fax

Practice location:
  • Phone: 928-581-0185
  • Fax:
Mailing address:
  • Phone: 928-581-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS RUBEN BONILLA
Title or Position: PRESIDENT
Credential: LPC
Phone: 928-581-0185