Provider Demographics
NPI:1356682165
Name:JONES, JACK
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 KANIS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3729
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:501-221-1553
Practice Address - Street 1:11700 KANIS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3729
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:501-221-1553
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health