=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295969509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BONNIE B KATZ MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2009
-----------------------------------------------------
Last Update Date | 05/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16550 VENTURA BLVD SUITE 405A
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-7714
-----------------------------------------------------
Fax | 818-343-5133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16550 VENTURA BLVD SUITE 405A
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-7714
-----------------------------------------------------
Fax | 818-343-5133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC41610
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------