Provider Demographics
NPI:1508113432
Name:BONHAM, DANIEL LAWRENCE
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:BONHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097
Mailing Address - Country:US
Mailing Address - Phone:530-841-4100
Mailing Address - Fax:530-841-4841
Practice Address - Street 1:2060 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:YERKA
Practice Address - State:CA
Practice Address - Zip Code:96094
Practice Address - Country:US
Practice Address - Phone:530-841-4100
Practice Address - Fax:530-841-4841
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist