1679642524 NPI number — MRS. JUDI K JONES LCSW

Table of content: MRS. JUDI K JONES LCSW (NPI 1679642524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679642524 NPI number — MRS. JUDI K JONES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JUDI
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
JUDY
Provider Other Middle Name:
KERSTETTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679642524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8017 BEAUMONT GREEN EAST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-595-8994
Provider Business Mailing Address Fax Number:
317-853-1314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10291 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
#160
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-595-8994
Provider Business Practice Location Address Fax Number:
317-853-1314
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34003233A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 123531 . This is a "MHN MANAGED HEALTH NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7145134 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000183101 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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