Provider Demographics
NPI:1316578735
Name:NYANGORO, JULIE BONZON (THERAPIST)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BONZON
Last Name:NYANGORO
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LOUIS
Other - Last Name:BONZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1791 ALUM CREEK DR # 43207
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1757
Mailing Address - Country:US
Mailing Address - Phone:614-445-8131
Mailing Address - Fax:
Practice Address - Street 1:88 N SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1756
Practice Address - Country:US
Practice Address - Phone:740-203-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA172337101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)