Provider Demographics
NPI:1679173819
Name:BOND, JUSTIN GLENN (NCC, LPC-A)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GLENN
Last Name:BOND
Suffix:
Gender:M
Credentials:NCC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 IRIS ROSE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1825
Mailing Address - Country:US
Mailing Address - Phone:281-795-8546
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3668
Practice Address - Country:US
Practice Address - Phone:281-903-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional