Provider Demographics
NPI:1326491051
Name:BONDY, JACILYN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JACILYN
Middle Name:
Last Name:BONDY
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14802 JONES MALTSBERGER RD STE 1101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3571
Mailing Address - Country:US
Mailing Address - Phone:210-490-4419
Mailing Address - Fax:
Practice Address - Street 1:14802 JONES MALTSBERGER RD STE 1101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3571
Practice Address - Country:US
Practice Address - Phone:432-661-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74374101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty