Provider Demographics
NPI:1376716613
Name:JONES, R JASON (MA, LPCC, LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:R JASON
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, LPCC, LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 EVENING ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3051
Mailing Address - Country:US
Mailing Address - Phone:614-580-8354
Mailing Address - Fax:614-847-0859
Practice Address - Street 1:930 EVENING ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3051
Practice Address - Country:US
Practice Address - Phone:614-580-8354
Practice Address - Fax:614-847-0859
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981013101YA0400X
OHE.0022020101YP2500X
OHS.0022020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker