Provider Demographics
NPI:1922212455
Name:BONDS, JENELLE SUZANNE (LPC)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:SUZANNE
Last Name:BONDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 OCEAN DR UNIT 5716
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5716
Mailing Address - Country:US
Mailing Address - Phone:361-825-2703
Mailing Address - Fax:
Practice Address - Street 1:6300 OCEAN DR UNIT 5716
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5716
Practice Address - Country:US
Practice Address - Phone:361-825-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161979302Medicaid