Provider Demographics
NPI:1255812384
Name:PONDER, NATASHA E (MHRT-CSP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:E
Last Name:PONDER
Suffix:
Gender:F
Credentials:MHRT-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1877
Mailing Address - Country:US
Mailing Address - Phone:075-326-5232
Mailing Address - Fax:207-532-3873
Practice Address - Street 1:11 MILL ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1877
Practice Address - Country:US
Practice Address - Phone:075-326-5232
Practice Address - Fax:207-532-3873
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor