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General NPI Number Information
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NPI Number | 1174390249
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Entity Type | Individual
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Provider Name | YVETTE G BONAVITA LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 17210 CAMPBELL RD STE 175
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City | DALLAS
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State | TX
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Zip | 75252-4201
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Country | US
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Telephone | 469-845-9855
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 E MOCKINGBIRD LN STE 147-850
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City | DALLAS
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State | TX
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Zip | 75214-2692
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Country | US
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Telephone | 214-734-2186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 32756
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 32756
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License Number State | TX
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