Provider Demographics
NPI:1043738982
Name:BOND, SHANNON (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21528 PAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6755
Mailing Address - Country:US
Mailing Address - Phone:512-736-9088
Mailing Address - Fax:
Practice Address - Street 1:18700 FM 1431 STE C
Practice Address - Street 2:
Practice Address - City:JONESTOWN
Practice Address - State:TX
Practice Address - Zip Code:78645-2415
Practice Address - Country:US
Practice Address - Phone:512-736-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73613101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional