Provider Demographics
NPI:1194520866
Name:BOND, MIRANDA MAE (LPC-T)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MAE
Last Name:BOND
Suffix:
Gender:
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 W WESTPORT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1558
Mailing Address - Country:US
Mailing Address - Phone:913-671-9220
Mailing Address - Fax:
Practice Address - Street 1:14202 W WESTPORT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1558
Practice Address - Country:US
Practice Address - Phone:913-671-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04970-T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional