Provider Demographics
NPI:1013537737
Name:JONES, JACQUELYN NICOLE (AMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-623-0331
Mailing Address - Fax:559-687-6459
Practice Address - Street 1:6520 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-623-0331
Practice Address - Fax:559-687-6459
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235235106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist