Provider Demographics
NPI:1558024703
Name:MATTHEWS, BONNIE JEAN (SUDRC#12240)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:SUDRC#12240
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 MELLUS ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1745
Mailing Address - Country:US
Mailing Address - Phone:925-229-0230
Mailing Address - Fax:
Practice Address - Street 1:904 MELLUS ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1745
Practice Address - Country:US
Practice Address - Phone:925-229-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12240101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor