Provider Demographics
NPI:1578804977
Name:BONNER, MOLLY T (MMFT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:T
Last Name:BONNER
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 GALE LN APT 135
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3098
Mailing Address - Country:US
Mailing Address - Phone:615-438-9609
Mailing Address - Fax:
Practice Address - Street 1:1815 DIVISION ST STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2727
Practice Address - Country:US
Practice Address - Phone:615-438-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist