Provider Demographics
NPI:1568683670
Name:JONES, ROBERT LLOYD (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LLOYD
Last Name:JONES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 SOUTH ONEIDA STREET
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-661-0884
Mailing Address - Fax:
Practice Address - Street 1:2129 SOUTH ONEIDA STREET
Practice Address - Street 2:SUITE 115
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-661-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14060131101YA0400X
WI682125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCASC2865OtherCERT. ADDICTIONS SPEC.
WILPC682-125OtherLICENSED PROF. COUNSELOR
WICADCD14060OtherCERT. ALCOL & DRUG
WI39278600Medicaid