Provider Demographics
NPI:1578179537
Name:JONES, BENJAMIN MAURICE
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MAURICE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CAMPUS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66506-2145
Mailing Address - Country:US
Mailing Address - Phone:423-402-0225
Mailing Address - Fax:
Practice Address - Street 1:1405 CAMPUS CREEK RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66506-2145
Practice Address - Country:US
Practice Address - Phone:423-402-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03186-T106H00000X
KS03254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist