Provider Demographics
NPI:1386013696
Name:JONES, KELLI NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6202
Mailing Address - Country:US
Mailing Address - Phone:830-629-6571
Mailing Address - Fax:830-608-1262
Practice Address - Street 1:1414 W SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6202
Practice Address - Country:US
Practice Address - Phone:830-629-6571
Practice Address - Fax:830-608-1262
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional