Provider Demographics
NPI:1619314416
Name:JONES, KATHRYN JOY (MFT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOY
Last Name:JONES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:6120 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-9749
Mailing Address - Country:US
Mailing Address - Phone:850-612-0169
Mailing Address - Fax:850-398-5628
Practice Address - Street 1:502A S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4238
Practice Address - Country:US
Practice Address - Phone:850-612-0169
Practice Address - Fax:850-398-5628
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL462646563OtherEIN