1851151021 NPI number — LARRY WAYNE JONES JR. LPC, M. DIV

Table of content: LARRY WAYNE JONES JR. LPC, M. DIV (NPI 1851151021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851151021 NPI number — LARRY WAYNE JONES JR. LPC, M. DIV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
LARRY
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
LPC, M. DIV
Provider Gender Code:
M

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:
1851151021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 80 BOX 13287
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96367-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 439
Provider Second Line Business Practice Location Address:
CAMP FOSTER MARINE CORPS BASE
Provider Business Practice Location Address City Name:
KITAMAE
Provider Business Practice Location Address State Name:
CHATAN-CHO OKINAWA
Provider Business Practice Location Address Postal Code:
9040117
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-645-5548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2024

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: 101YP2500X , with the licence number:  LPC.0017371 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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