Provider Demographics
NPI:1326193095
Name:JONES, CHRISTINE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8578
Mailing Address - Country:US
Mailing Address - Phone:307-760-0504
Mailing Address - Fax:307-742-2449
Practice Address - Street 1:17 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8578
Practice Address - Country:US
Practice Address - Phone:307-760-0504
Practice Address - Fax:307-742-2449
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health