Provider Demographics
NPI:1558474585
Name:JONES, MARK STEPHEN (LLP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:JONES
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SUPERIOR ST
Mailing Address - Street 2:STE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3771
Mailing Address - Country:US
Mailing Address - Phone:810-966-1972
Mailing Address - Fax:810-966-1973
Practice Address - Street 1:805 SUPERIOR ST
Practice Address - Street 2:STE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3771
Practice Address - Country:US
Practice Address - Phone:810-966-1972
Practice Address - Fax:810-966-1973
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011246101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health