Provider Demographics
NPI:1346854148
Name:JONES, JUSTIN DARRELL PRESTON (MA MFT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DARRELL PRESTON
Last Name:JONES
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:PRESTON
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:205 169TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4523
Mailing Address - Country:US
Mailing Address - Phone:425-246-2654
Mailing Address - Fax:
Practice Address - Street 1:2200 112TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2951
Practice Address - Country:US
Practice Address - Phone:425-905-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61109773101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor