Mary Lou Bonham, BSN, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

1500 NE Irving St
Suite 250
Portland, OR 97232-2243

Phone

(503) 233-4356

NPI assigned

Oct 4, 2007

Last updated

Oct 4, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 3, 2024 through Jan 3, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1316135288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6445 SE 71ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972066545",
            "telephone_number": "541-974-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NE IRVING ST",
            "address_2": "SUITE 250",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322243",
            "telephone_number": "503-233-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONHAM",
        "first_name": "MARY",
        "middle_name": "LOU",
        "name_prefix": "Ms.",
        "credential": "BSN, MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soohan Bong
• Christina Bongen
• Adrienne D Bonham, MD
• Jeffrey A Bonham, MD
• Madison Paschal Bonham, PA
• Erica Leah Boni
• Lelia Boniadi, OTR/L
• Ashley Bonifacio
• Allison D Bonifay, MA, LPC
• Amy Grace Bonilla

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.