Individual
DR. DEBORAH A BONITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
1310 24TH AVE S, MENTAL HEALTH ANNEX ROOM 106, NASHVILLE, TN 37212-2637
(615) 873-7408
Mailing address
1310 24TH AVE S, MENTAL HEALTH ANNEX ROOM 106, NASHVILLE, TN 37212-2637
(615) 873-7408
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301012381
MI
103TC0700X
Clinical Psychologist
Primary
6301012381
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
381870664
TAX ID
MI
01
—
680G312080
BLUE CROSS BLUE SHIELD
MI
01
—
DB012381
LICENSE
MI
Enumeration date
01/25/2007
Last updated
02/07/2018
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