Provider Demographics
NPI:1437384591
Name:JONES, PHYLLIS G (LMHP, CMSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:G
Last Name:JONES
Suffix:
Gender:F
Credentials:LMHP, CMSW
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:G
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMSW
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1851
Mailing Address - Country:US
Mailing Address - Phone:402-444-4755
Mailing Address - Fax:402-444-3943
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1851
Practice Address - Country:US
Practice Address - Phone:402-444-4755
Practice Address - Fax:402-444-3943
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE924104100000X
NE107104100000X
NCC002083104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker