Provider Demographics
NPI:1265448849
Name:JONES, JOHN EGAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EGAN
Last Name: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 1:307 LAKE FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4745
Mailing Address - Country:US
Mailing Address - Phone:318-443-7284
Mailing Address - Fax:
Practice Address - Street 1:401 RAINBOW DR
Practice Address - Street 2:UNIT 35
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6979
Practice Address - Country:US
Practice Address - Phone:318-487-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9759OtherBLUECROSSBLUESHIELD
LA5DL60Medicare PIN