Provider Demographics
NPI:1023214806
Name:JONES, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 COLLEGE PARK DR SW UNIT 58
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-8430
Mailing Address - Country:US
Mailing Address - Phone:541-619-8088
Mailing Address - Fax:
Practice Address - Street 1:777 COLLEGE PARK DR SW UNIT 58
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-8430
Practice Address - Country:US
Practice Address - Phone:541-619-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health