Basic Information
| Provider Information | |||||||||
| NPI: | 1861967135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONNHEIM | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | NIREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 153 MADRONA PL E | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176450160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2033 6TH AVE STE 826 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981212593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062576600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2018 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH61272330 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.