Provider Demographics
NPI:1619481579
Name:JONES, CHESTER ALPHONZO JR (CART,LCDC-INTERN,LPC)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:ALPHONZO
Last Name:JONES
Suffix:JR
Gender:M
Credentials:CART,LCDC-INTERN,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3841
Mailing Address - Country:US
Mailing Address - Phone:361-549-4910
Mailing Address - Fax:
Practice Address - Street 1:4129 WESTERN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-3841
Practice Address - Country:US
Practice Address - Phone:361-549-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74566101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health