=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649840943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONA PSYCHOLOGY SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2021
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22020 CLARENDON ST STE 208
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-6322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-288-8505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6442 PLATT AVE # 1507
-----------------------------------------------------
City | WEST HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91307-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-288-8505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STACEY R BONA
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 310-403-5695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------