Provider Demographics
NPI:1437985405
Name:TYREE, BONITA (CT)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:
Last Name:TYREE
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 UPPER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2352
Mailing Address - Country:US
Mailing Address - Phone:216-408-4340
Mailing Address - Fax:
Practice Address - Street 1:6700 BETA DR STE 108
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2335
Practice Address - Country:US
Practice Address - Phone:440-460-0140
Practice Address - Fax:440-460-5413
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.240587-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health