Provider Demographics
NPI:1376963579
Name:JONES, SIMONNE CASSANDRA
Entity Type:Individual
Prefix:MRS
First Name:SIMONNE
Middle Name:CASSANDRA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIMONNE
Other - Middle Name:CASSANDRA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 S. DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120
Mailing Address - Country:US
Mailing Address - Phone:918-508-4563
Mailing Address - Fax:
Practice Address - Street 1:9177 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-5939
Practice Address - Country:US
Practice Address - Phone:918-899-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK080777677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health