Provider Demographics
NPI:1538331079
Name:TONKONOGY, MARINA (MFT)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:TONKONOGY
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 1:3625 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3626
Mailing Address - Country:US
Mailing Address - Phone:818-564-7703
Mailing Address - Fax:
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 168
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3626
Practice Address - Country:US
Practice Address - Phone:818-564-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist