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General NPI Number Information
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NPI Number | 1588912604
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Entity Type | Individual
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Provider Name | JEREMY BONTA LMHC
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Gender | Male
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 9625 N MILITARY TRL
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5498
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Country | US
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Telephone | 561-622-5423
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Fax | 772-546-8434
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Provider Business Mailing Address
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Address Line | 9625 N MILITARY TRL
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5498
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Country | US
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Telephone | 561-622-5423
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Fax | 772-546-8434
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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