Provider Demographics
NPI:1376762963
Name:JONES, KENNETH C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
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 703
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-0703
Mailing Address - Country:US
Mailing Address - Phone:817-714-6809
Mailing Address - Fax:866-372-7985
Practice Address - Street 1:906 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4836
Practice Address - Country:US
Practice Address - Phone:817-714-6809
Practice Address - Fax:866-372-7985
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280045001OtherMEDICAID - REGENESIS
TX1386961837OtherNPI - REGENESIS
TX280046801Medicaid
TX280045001OtherMEDICAID - REGENESIS