Provider Demographics
NPI:1801445176
Name:BONILLA, LIZETTE (LMFT)
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4100
Mailing Address - Country:US
Mailing Address - Phone:133-818-5002
Mailing Address - Fax:
Practice Address - Street 1:1147 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4100
Practice Address - Country:US
Practice Address - Phone:213-381-8500
Practice Address - Fax:213-381-9410
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist