Provider Demographics
NPI:1609405976
Name:JONES, TIA MARIE (BA)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3580 INSPIRATION DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2717
Mailing Address - Country:US
Mailing Address - Phone:330-501-2925
Mailing Address - Fax:
Practice Address - Street 1:8170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6434
Practice Address - Country:US
Practice Address - Phone:847-306-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH474455106S00000X
CO1-23-70020103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician