Provider Demographics
NPI:1467587469
Name:CHRISTNER, BONNIE JO (PSYD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:CHRISTNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:CHRISTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT, PSYD
Mailing Address - Street 1:PO BOX 260088
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0088
Mailing Address - Country:US
Mailing Address - Phone:818-879-7777
Mailing Address - Fax:877-351-2003
Practice Address - Street 1:16858 CLARK ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1066
Practice Address - Country:US
Practice Address - Phone:818-674-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15532103TC0700X, 103TP2701X
WAPY2971103TC0700X
PAMFT381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-456936OtherFEDERAL ID NUMBER