1982764445 NPI number — DR. EDWARD ANTHONY JONES ED.D., CCMHC, LMFT

Table of content: DR. EDWARD ANTHONY JONES ED.D., CCMHC, LMFT (NPI 1982764445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982764445 NPI number — DR. EDWARD ANTHONY JONES ED.D., CCMHC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
EDWARD
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D., CCMHC, LMFT
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:
1982764445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6905 KENTUCKY DAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-9339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-444-0411
Provider Business Mailing Address Fax Number:
888-298-7296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FOUNTAIN AVE
Provider Second Line Business Practice Location Address:
CENTURY BUILDING -- SUITE 105
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001-2771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-0411
Provider Business Practice Location Address Fax Number:
888-298-7296
Provider Enumeration Date:
12/12/2006

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:  KY 0202 , 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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