Provider Demographics
NPI:1639439490
Name:JONES, TERESA JAMETTE
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JAMETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-0324
Mailing Address - Country:US
Mailing Address - Phone:405-501-8717
Mailing Address - Fax:
Practice Address - Street 1:1319 E VILAS AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5420
Practice Address - Country:US
Practice Address - Phone:405-501-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation