Provider Demographics
NPI:1487430534
Name:MARTINEZ, BONNIE SUNSHINE (MFTRI)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:SUNSHINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MFTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 W SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7775
Mailing Address - Country:US
Mailing Address - Phone:208-406-0880
Mailing Address - Fax:
Practice Address - Street 1:110 E WALLACE AVE STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2948
Practice Address - Country:US
Practice Address - Phone:208-406-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFTI-9838106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist