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General NPI Number Information
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NPI Number | 1114533114
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Entity Type | Organization
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Legal Business Name | BONITA COUNSELING CENTER
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 425 W. BONITA AVE., STE 204
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-592-4152
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Fax | 909-592-2912
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Provider Business Mailing Address
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Address Line | 425 W. BONITA AVE., STE 204
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-592-4152
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Fax | 909-592-2912
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Authorized Official
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Title or Position | THERAPIST/PARTNER
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Name | MR. MICHAEL EDWARD MCCLARY
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Credential | LMFT
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Telephone | 626-695-0425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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