Provider Demographics
NPI:1710424890
Name:KELLY JONES PSY.D.
Entity Type:Organization
Organization Name:KELLY JONES PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-432-9511
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:1S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7257
Mailing Address - Country:US
Mailing Address - Phone:509-432-9511
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:1S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7257
Practice Address - Country:US
Practice Address - Phone:509-432-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health