Provider Demographics
NPI:1154983187
Name:BONY, ALEXANDER STAVROS
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:STAVROS
Last Name:BONY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 HIGHWAY 41 STE D
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9657
Mailing Address - Country:US
Mailing Address - Phone:559-667-2101
Mailing Address - Fax:209-317-4020
Practice Address - Street 1:5320 HIGHWAY 49 N STE 4
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9588
Practice Address - Country:US
Practice Address - Phone:559-683-2084
Practice Address - Fax:209-317-4020
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program