Provider Demographics
NPI:1780877167
Name:EARLY, BONNIE N (MFT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:N
Last Name:EARLY
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 1:2121 NATOMAS CROSSING DR
Mailing Address - Street 2:SUITE 200-337
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3847
Mailing Address - Country:US
Mailing Address - Phone:916-833-5171
Mailing Address - Fax:
Practice Address - Street 1:180 PROMENADE CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2939
Practice Address - Country:US
Practice Address - Phone:916-833-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist