Provider Demographics
NPI:1639225717
Name:JONES, JOHN PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
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 1:5199 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9550
Mailing Address - Country:US
Mailing Address - Phone:231-546-2027
Mailing Address - Fax:989-732-2551
Practice Address - Street 1:606 N COURT AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1516
Practice Address - Country:US
Practice Address - Phone:989-732-6488
Practice Address - Fax:989-732-2551
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003256103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI087989OtherVALUE OPTIONS ID
MIJJ003256OtherSTATE NO
MI277152000OtherMAGELLAN PIN NO.
MI11255933OtherCAQH ID
MI680F910370OtherBCBS PIN NO
MI087989OtherVALUE OPTIONS ID
MIOF34777Medicare PIN