Healthcare Provider Details

I. General information

NPI: 1770457418
Provider Name (Legal Business Name): MARY LOUISE HEGARTY-BONTRAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/24/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE CIR
CHICO CA
95973-0258
US

IV. Provider business mailing address

452 E 6TH ST
CHICO CA
95928-5633
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-7889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: