Provider Demographics
NPI:1073790036
Name:DOUGHTY, BONNIE K (MFT)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:K
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2255
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-6655
Mailing Address - Country:US
Mailing Address - Phone:510-306-7196
Mailing Address - Fax:
Practice Address - Street 1:251 LAFAYETTE CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4342
Practice Address - Country:US
Practice Address - Phone:925-284-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health