Healthcare Provider Details

I. General information

NPI: 1538098223
Provider Name (Legal Business Name): SPENCER LAMAR BONDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 S FIRST ST NE
BROOKHAVEN MS
39601-4762
US

IV. Provider business mailing address

1094 S FIRST ST NE
BROOKHAVEN MS
39601-4762
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-7154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: