Provider Demographics
NPI:1477611440
Name:JONES, BRUCE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 WILLIAMS WAY E
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-8714
Mailing Address - Country:US
Mailing Address - Phone:765-644-2667
Mailing Address - Fax:765-640-1102
Practice Address - Street 1:1721 WILLIAMS WAY E
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-8714
Practice Address - Country:US
Practice Address - Phone:765-644-2667
Practice Address - Fax:765-640-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YA0400X, 106H00000X
IN34002465A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist