Healthcare Provider Details

I. General information

NPI: 1396073185
Provider Name (Legal Business Name): BONNIE LOUISE HOAG M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SIR FRANCIS DRAKE BLVD. STE. F.
KENTFIELD CA
94904
US

IV. Provider business mailing address

905 SIR FRANCIS DRAKE BLVD. STE. F.
KENTFIELD CA
94904
US

V. Phone/Fax

Practice location:
  • Phone: 415-485-1177
  • Fax: 415-459-7420
Mailing address:
  • Phone: 415-485-1177
  • Fax: 415-459-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberME15908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: