1588830046 NPI number — MISS TRALANA EVON JONES LMSW

Table of content: MISS TRALANA EVON JONES LMSW (NPI 1588830046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588830046 NPI number — MISS TRALANA EVON JONES LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
TRALANA
Provider Middle Name:
EVON
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588830046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7425 E 17TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67206-1067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-201-3233
Provider Business Mailing Address Fax Number:
316-221-1099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 E WILLIAM ST
Provider Second Line Business Practice Location Address:
SUITE # 308
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67202-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-201-3233
Provider Business Practice Location Address Fax Number:
316-221-1099
Provider Enumeration Date:
05/05/2008

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: 104100000X , with the licence number:  8568 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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