Provider Demographics
NPI:1629464425
Name:JONES, WARREN (MED)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8196 N MARABOU DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8845
Mailing Address - Country:US
Mailing Address - Phone:208-777-5294
Mailing Address - Fax:
Practice Address - Street 1:8196 N MARABOU DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8845
Practice Address - Country:US
Practice Address - Phone:208-777-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional