Healthcare Provider Details

I. General information

NPI: 1023833209
Provider Name (Legal Business Name): BONNY DOON UNION ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 PINE FLAT RD
SANTA CRUZ CA
95060-9711
US

IV. Provider business mailing address

1492 PINE FLAT RD
SANTA CRUZ CA
95060-9711
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-2300
  • Fax:
Mailing address:
  • Phone: 831-427-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKE HEFFNER
Title or Position: SUPERINTENDENT-PRINCIPAL
Credential:
Phone: 831-427-2300