Provider Demographics
NPI:1356674105
Name:JONES, MICHAEL STEPHEN (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:JONES
Suffix:
Gender:M
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 N COLLEGE AVE
Mailing Address - Street 2:APARTMENT 702
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3185
Mailing Address - Country:US
Mailing Address - Phone:317-532-7289
Mailing Address - Fax:
Practice Address - Street 1:8510 EVERGREEN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2338
Practice Address - Country:US
Practice Address - Phone:317-778-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042631A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201130340Medicaid