Provider Demographics
NPI:1700641586
Name:MONONO, MONDOA
Entity Type:Individual
Prefix:
First Name:MONDOA
Middle Name:
Last Name:MONONO
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 1:2326 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3678
Mailing Address - Country:US
Mailing Address - Phone:682-375-6750
Mailing Address - Fax:
Practice Address - Street 1:210 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4523
Practice Address - Country:US
Practice Address - Phone:214-351-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health