1306947627 NPI number — MRS. JONA M KEETON LMFT, PMHCNS-BC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306947627 NPI number — MRS. JONA M KEETON LMFT, PMHCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEETON
Provider First Name:
JONA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT, PMHCNS-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEETON
Provider Other First Name:
JONA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PASTORAL COUNSELOR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306947627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
361 TOWNE CENTER PL
Provider Second Line Business Mailing Address:
SUITE 1300
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157-4869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-977-9353
Provider Business Mailing Address Fax Number:
601-977-9422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
361 TOWNE CENTER PL
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-4869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-977-9353
Provider Business Practice Location Address Fax Number:
601-977-9422
Provider Enumeration Date:
09/26/2006

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: 106H00000X , with the licence number:  T0203 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0809X , with the licence number: R533084 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 20 520558L . This is a "TAX ID FOR A BRIDGE TO RECOVERY" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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