Provider Demographics
NPI:1043448061
Name:IRONS, JORY W (MA)
Entity Type:Individual
Prefix:
First Name:JORY
Middle Name:W
Last Name:IRONS
Suffix:
Gender:M
Credentials:MA
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 293731
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-3731
Mailing Address - Country:US
Mailing Address - Phone:916-667-6754
Mailing Address - Fax:
Practice Address - Street 1:6515 VALLEY HI DRIVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-9323
Practice Address - Country:US
Practice Address - Phone:916-450-2650
Practice Address - Fax:916-681-6354
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96956106H00000X
CA59887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist