Healthcare Provider Details

I. General information

NPI: 1699249573
Provider Name (Legal Business Name): MARY BONOUGHOUNIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W OCEAN BLVD STE 800
LONG BEACH CA
90802-4529
US

IV. Provider business mailing address

444 W OCEAN BLVD STE 800
LONG BEACH CA
90802-4529
US

V. Phone/Fax

Practice location:
  • Phone: 310-617-9582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: