1265836456 NPI number — MRS. ELIZABETH RUTH JONES LCSW

Table of content: MRS. ELIZABETH RUTH JONES LCSW (NPI 1265836456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265836456 NPI number — MRS. ELIZABETH RUTH JONES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
ELIZABETH
Provider Middle Name:
RUTH
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:
SMITH
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265836456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 614
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-0614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-886-2205
Provider Business Mailing Address Fax Number:
270-886-0392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 RUSSELVILLE RD
Provider Second Line Business Practice Location Address:
GENESIS EAST
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-8095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-887-5697
Provider Business Practice Location Address Fax Number:
270-887-5849
Provider Enumeration Date:
10/16/2014

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:  253834 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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