Provider Demographics
NPI:1497063432
Name:JONES, ANGELA MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:BODLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1003 SE 14TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6897
Mailing Address - Country:US
Mailing Address - Phone:479-408-3200
Mailing Address - Fax:479-358-1430
Practice Address - Street 1:1003 SE 14TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6897
Practice Address - Country:US
Practice Address - Phone:479-408-3200
Practice Address - Fax:479-358-1430
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15-19P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190197719Medicaid
MO431560263OtherTRICARE
MOP01037205OtherRR MCR
MO132680255Medicare UPIN
MO1497063432Medicaid