Provider Demographics
NPI:1881973170
Name:BONI, TINA MICHELLE (MA, PSYD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:MICHELLE
Last Name:BONI
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 RIVERSIDE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5393
Mailing Address - Country:US
Mailing Address - Phone:412-471-6154
Mailing Address - Fax:615-657-7343
Practice Address - Street 1:377 RIVERSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5393
Practice Address - Country:US
Practice Address - Phone:615-471-6154
Practice Address - Fax:615-657-7343
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000004430101YP2500X
PABH001420103K00000X
TN4070103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440027Medicaid
PA328834A336347OtherVALUE BEHAVIORAL HEALTH