Basic Information
| Provider Information | |||||||||
| NPI: | 1215392899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOND | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 256 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04271 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 256 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0000000000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2015 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0012694 | CO | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 67390 | TX | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 0012694 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 31025 | MT | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | CC6412 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.