Provider Demographics
NPI:1700366051
Name:JONES, KELLY SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
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 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-539-0683
Mailing Address - Fax:940-228-0651
Practice Address - Street 1:1602 W BUSINESS 380 STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3267
Practice Address - Country:US
Practice Address - Phone:940-539-0683
Practice Address - Fax:940-228-0651
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX397914801Medicaid
TX8KY713OtherBCBS