Provider Demographics
NPI:1174754576
Name:MARTELLO, BONNIE E (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:E
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:E
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:25830 OAK FOREST CT
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9460
Mailing Address - Country:US
Mailing Address - Phone:530-320-2027
Mailing Address - Fax:
Practice Address - Street 1:195 AGNES ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4710
Practice Address - Country:US
Practice Address - Phone:530-320-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist