1588145593 NPI number — GISELLE L JONES, LICENSED CLINICAL SOCIAL WORKER, INC

Table of content: (NPI 1588145593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588145593 NPI number — GISELLE L JONES, LICENSED CLINICAL SOCIAL WORKER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GISELLE L JONES, LICENSED CLINICAL SOCIAL WORKER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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NPI Number Information

NPI Number:
1588145593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 FAIR OAKS AVE # 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91030-3311
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:
1741 SILVER LAKE BLVD STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-517-7347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
GISELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-686-1778

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  77482 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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