Provider Demographics
NPI:1114544814
Name:JONES, LATASHA YVETTE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:YVETTE
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:PO BOX 12531
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93778-2531
Mailing Address - Country:US
Mailing Address - Phone:559-246-7000
Mailing Address - Fax:
Practice Address - Street 1:412 F ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3409
Practice Address - Country:US
Practice Address - Phone:559-498-6988
Practice Address - Fax:559-485-6548
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71120101YM0800X
CA107610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health