MEDICARE: LISA DAWN BOND LPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0905	KY
2	103TC0700X	Clinical Psychologist	175264	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000689151	OTHER		ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801059043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DAWN BOND LPP

Provider Business Mailing Address
First Line	:	161 PROSPEROUS PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1898
Country	:	US
Telephone Number	:	859-368-0609
Fax Number	:	859-368-9767

Provider Business Practice Location Address
First Line	:	161 PROSPEROUS PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1898
Country	:	US
Telephone Number	:	859-368-0609
Fax Number	:	859-368-9767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	03/17/2018

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