Provider Demographics
NPI:1619574035
Name:JONES, TRIDENA JOHNSON (LCDC)
Entity Type:Individual
Prefix:
First Name:TRIDENA
Middle Name:JOHNSON
Last Name:JONES
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 CROW RD STE A&B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7082
Mailing Address - Country:US
Mailing Address - Phone:409-813-2206
Mailing Address - Fax:
Practice Address - Street 1:4349 CROW RD STE A&B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7082
Practice Address - Country:US
Practice Address - Phone:409-813-2206
Practice Address - Fax:409-813-2236
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10521101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor