Basic Information
Provider Information
NPI: 1013383710
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOND
FirstName: LAUREN
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5800 W 10TH ST
Address2: SUITE 600
City: LITTLE ROCK
State: AR
PostalCode: 722041752
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5800 W 10TH ST
Address2: SUITE 600
City: LITTLE ROCK
State: AR
PostalCode: 722041752
CountryCode: US
TelephoneNumber: 5016668686
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2015
LastUpdateDate: 05/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XA1604057ARY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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