Provider Demographics
NPI:1124496930
Name:BONNYCASTLE, CYNTHIA (LMFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BONNYCASTLE
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 1:715 APRIL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3775
Mailing Address - Country:US
Mailing Address - Phone:657-229-4325
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 131
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3820
Practice Address - Country:US
Practice Address - Phone:657-229-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist