Provider Demographics
NPI:1801387816
Name:BONNER, BRENDAN (LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BONNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N LARCHMONT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3754
Mailing Address - Country:US
Mailing Address - Phone:213-632-6861
Mailing Address - Fax:
Practice Address - Street 1:252 N LARCHMONT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3754
Practice Address - Country:US
Practice Address - Phone:213-632-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist