Provider Demographics
NPI:1609031582
Name:JONES, R. TERRY (MD)
Entity Type:Individual
Prefix:MR
First Name:R. TERRY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PALMER PARK BLVD
Mailing Address - Street 2:#104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3402
Mailing Address - Country:US
Mailing Address - Phone:719-596-4222
Mailing Address - Fax:719-265-6655
Practice Address - Street 1:4020 PALMER PARK BLVD
Practice Address - Street 2:#104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3402
Practice Address - Country:US
Practice Address - Phone:719-596-4222
Practice Address - Fax:719-265-6655
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist