Provider Demographics
NPI:1215512967
Name:BONDS, QUINTON L (MA MFT)
Entity type:Individual
Prefix:
First Name:QUINTON
Middle Name:L
Last Name:BONDS
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 N 5TH ST APT 222
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-5805
Mailing Address - Country:US
Mailing Address - Phone:612-251-7779
Mailing Address - Fax:
Practice Address - Street 1:1011 W BROADWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2531
Practice Address - Country:US
Practice Address - Phone:612-251-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A