Provider Demographics
NPI:1023568458
Name:TEW, MARY KRISTINA JONES
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KRISTINA JONES
Last Name:TEW
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-0057
Mailing Address - Country:US
Mailing Address - Phone:601-447-7188
Mailing Address - Fax:
Practice Address - Street 1:626 5TH ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:LA
Practice Address - Zip Code:70079-2308
Practice Address - Country:US
Practice Address - Phone:601-447-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCI 5431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health