Provider Demographics
NPI:1679825178
Name:BONDS, KEITH R
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:BONDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 NW 151ST CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1144
Mailing Address - Country:US
Mailing Address - Phone:405-626-2162
Mailing Address - Fax:
Practice Address - Street 1:605 NW 151ST CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1144
Practice Address - Country:US
Practice Address - Phone:405-626-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional