Provider Demographics
NPI:1053482539
Name:JONES, PATRICIA ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:JAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 784
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453
Mailing Address - Country:US
Mailing Address - Phone:707-263-8888
Mailing Address - Fax:707-263-8899
Practice Address - Street 1:1495 ORCHID WAY
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-3725
Practice Address - Country:US
Practice Address - Phone:707-263-8888
Practice Address - Fax:707-263-8899
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist