Provider Demographics
NPI:1225222185
Name:JONES, IRENE B (MED)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:MED
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 3253
Mailing Address - Street 2:116 HAWK CT
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-3253
Mailing Address - Country:US
Mailing Address - Phone:928-608-4170
Mailing Address - Fax:928-645-9243
Practice Address - Street 1:434 S LAKE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-608-4170
Practice Address - Fax:928-645-9243
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3102743101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool