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General NPI Number Information
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NPI Number | 1295554210
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Entity Type | Organization
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Legal Business Name | BONILLA BEHAVIORAL HEALTH, PLLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 7247 DAZZLE POINT ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-4745
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Country | US
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Telephone | 323-875-4843
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Fax |
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Provider Business Mailing Address
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Address Line | 7247 DAZZLE POINT ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-4745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, FOUNDER
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Name | LEAH BONILLA
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Credential | PHD, LLP
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Telephone | 323-875-4843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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