Provider Demographics
NPI:1841309978
Name:BONNETT, GEORGE CHRISTOPHER (MFT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:BONNETT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 GREENBACK LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2551
Mailing Address - Country:US
Mailing Address - Phone:916-765-1450
Mailing Address - Fax:
Practice Address - Street 1:8146 GREENBACK LN
Practice Address - Street 2:SUITE 206
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2551
Practice Address - Country:US
Practice Address - Phone:916-765-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2490Medicaid