Provider Demographics
NPI:1588021067
Name:JONES, AUDRA ANN (MSED, LPCC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 PATRIOT BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1170
Mailing Address - Country:US
Mailing Address - Phone:309-530-2433
Mailing Address - Fax:
Practice Address - Street 1:5760 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1170
Practice Address - Country:US
Practice Address - Phone:330-953-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health