Provider Demographics
NPI:1366655250
Name:JONES, GWENDOLYN (LPC)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281302
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38168-1302
Mailing Address - Country:US
Mailing Address - Phone:901-386-3414
Mailing Address - Fax:901-383-1510
Practice Address - Street 1:3815 HAWKINS MILL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5207
Practice Address - Country:US
Practice Address - Phone:901-386-3414
Practice Address - Fax:901-383-1510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health