Provider Demographics
NPI:1932697109
Name:LOVE, BONNIE (MFT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 SEAVIEW AVE # B
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1646
Mailing Address - Country:US
Mailing Address - Phone:805-458-3674
Mailing Address - Fax:
Practice Address - Street 1:2170 SEAVIEW AVE # B
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1646
Practice Address - Country:US
Practice Address - Phone:805-458-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693447164X00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No164X00000XNursing Service ProvidersLicensed Vocational Nurse