Provider Demographics
NPI:1528554011
Name:JONES, KAYLA R
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 WEST LN APT 205
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3398
Mailing Address - Country:US
Mailing Address - Phone:209-915-7319
Mailing Address - Fax:
Practice Address - Street 1:5637 N PERSHING AVE STE B7
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4955
Practice Address - Country:US
Practice Address - Phone:209-800-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician