Provider Demographics
NPI:1235295726
Name:VAN JONES, ANTHONY M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:VAN JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 HIGH SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6623
Mailing Address - Country:US
Mailing Address - Phone:134-740-9852
Mailing Address - Fax:718-237-4434
Practice Address - Street 1:3947 HIGH SUMMIT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6623
Practice Address - Country:US
Practice Address - Phone:347-409-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027465-1101YM0800X
TX601641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health