Provider Demographics
NPI:1568195675
Name:JONES, SHAMEKA
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:
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 1:17618 LITTLE BOUGH LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-5208
Mailing Address - Country:US
Mailing Address - Phone:832-257-5336
Mailing Address - Fax:
Practice Address - Street 1:17618 LITTLE BOUGH LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-5208
Practice Address - Country:US
Practice Address - Phone:832-257-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29590111Medicaid