Healthcare Provider Details

I. General information

NPI: 1265260202
Provider Name (Legal Business Name): SHATARA BONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date: 02/09/2026
Reactivation Date: 07/29/2026

III. Provider practice location address

1010 W RALPH HALL PKWY STE 112
ROCKWALL TX
75032-6690
US

IV. Provider business mailing address

1010 W RALPH HALL PKWY STE 112
ROCKWALL TX
75032-6690
US

V. Phone/Fax

Practice location:
  • Phone: 972-865-8782
  • Fax: 972-499-6935
Mailing address:
  • Phone: 512-956-6463
  • Fax: 866-653-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: