Provider Demographics
NPI:1881412096
Name:BOND PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:BOND PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVEREST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-440-9455
Mailing Address - Street 1:1678 SELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6149
Mailing Address - Country:US
Mailing Address - Phone:124-409-4556
Mailing Address - Fax:
Practice Address - Street 1:1678 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6149
Practice Address - Country:US
Practice Address - Phone:612-440-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty