Provider Demographics
NPI:1295906089
Name:BONNEY, WILLIAM EARL (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EARL
Last Name:BONNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 W DR MLK JR BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-872-8034
Mailing Address - Fax:813-870-2324
Practice Address - Street 1:1936 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-872-8034
Practice Address - Fax:813-870-2324
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0004919225700000X
FLMH0001106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist