Provider Demographics
NPI:1598971178
Name:JONES, MARK HAROLD (MS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HAROLD
Last Name:JONES
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21938 S HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-8051
Mailing Address - Country:US
Mailing Address - Phone:918-456-3188
Mailing Address - Fax:918-456-3188
Practice Address - Street 1:1325 E BOONE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3361
Practice Address - Country:US
Practice Address - Phone:918-456-3188
Practice Address - Fax:918-456-3188
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK586101YP2500X
OK089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist