Healthcare Provider Details

I. General information

NPI: 1881973170
Provider Name (Legal Business Name): TINA MICHELLE BONI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 RIVERSIDE DR STE 302
FRANKLIN TN
37064-5393
US

IV. Provider business mailing address

377 RIVERSIDE DR STE 302
FRANKLIN TN
37064-5393
US

V. Phone/Fax

Practice location:
  • Phone: 615-471-6154
  • Fax: 615-657-7343
Mailing address:
  • Phone: 615-722-0565
  • Fax: 615-583-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23633
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH001420
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4070
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000004430
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: