Provider Demographics
NPI:1225339963
Name:BONDS, LORETTA (MSCI,S)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:
Last Name:BONDS
Suffix:
Gender:F
Credentials:MSCI,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 NW 113TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7617
Mailing Address - Country:US
Mailing Address - Phone:405-922-2079
Mailing Address - Fax:406-608-4570
Practice Address - Street 1:1330 N CLASSEN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6834
Practice Address - Country:US
Practice Address - Phone:405-308-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst