MEDICARE: DR. TINA MICHELLE BONI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4070	TN
2	101YP2500X	Professional Counselor	LPC0000004430	TN
3	103K00000X	Behavior Analyst	BH001420	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881973170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA MICHELLE BONI PSY.D.

Provider Business Mailing Address
First Line	:	377 RIVERSIDE DR STE 302
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5393
Country	:	US
Telephone Number	:	615-722-0565
Fax Number	:	615-583-7252

Provider Business Practice Location Address
First Line	:	377 RIVERSIDE DR STE 302
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5393
Country	:	US
Telephone Number	:	615-471-6154
Fax Number	:	615-657-7343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	09/05/2025

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