Provider Demographics
NPI:1407623705
Name:JONES, MADELINE ELIZABETH (MED, EDS, NCC, APC)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:JONES
Suffix:
Gender:F
Credentials:MED, EDS, NCC, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 YORKTOWN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1921
Mailing Address - Country:US
Mailing Address - Phone:979-229-1436
Mailing Address - Fax:
Practice Address - Street 1:4500 YORKTOWN ST UNIT A
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1921
Practice Address - Country:US
Practice Address - Phone:979-229-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021117101YP2500X
GAAPC008817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional