Provider Demographics
NPI:1619904778
Name:JONES, KEVIN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 GARTH RD
Mailing Address - Street 2:SUITE A-300
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2153
Mailing Address - Country:US
Mailing Address - Phone:281-427-1115
Mailing Address - Fax:
Practice Address - Street 1:4721 GARTH RD
Practice Address - Street 2:SUITE A-300
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2153
Practice Address - Country:US
Practice Address - Phone:281-427-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680007408OtherRAIL ROAD
TX128059601Medicaid
TX128059602Medicaid
TX128059603Medicaid
TXP000DX100Medicaid
TX86111AOtherBLUE CROSS BLUE SHIELD
TX00DX10Medicare ID - Type UnspecifiedFOR PRIVATE PRACTICE
TX680007408OtherRAIL ROAD
TX86111AOtherBLUE CROSS BLUE SHIELD
TXR57395Medicare UPIN