Healthcare Provider Details

I. General information

NPI: 1336363282
Provider Name (Legal Business Name): BONNIE GOULD RN, M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/01/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CAMPISI WAY SUITE 350
CAMPBELL CA
95008
US

IV. Provider business mailing address

1484 POLLARD RD # 256
LOS GATOS CA
95032-1031
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-2240
  • Fax:
Mailing address:
  • Phone: 408-356-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC# 39861
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number294441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: