Provider Demographics
NPI:1548399165
Name:BOND, SHANNON MELISSA TAYLOR (BA, CAC-M)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MELISSA TAYLOR
Last Name:BOND
Suffix:
Gender:F
Credentials:BA, CAC-M
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:MELISSA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:508 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2329
Mailing Address - Country:US
Mailing Address - Phone:989-752-7867
Mailing Address - Fax:
Practice Address - Street 1:508 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2329
Practice Address - Country:US
Practice Address - Phone:989-752-7867
Practice Address - Fax:989-752-6830
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)