Provider Demographics
NPI:1740223254
Name:JONES, TATYANA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:G
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 IMPERIAL HWY
Mailing Address - Street 2:HB 226
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-401-8192
Mailing Address - Fax:562-401-6678
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:RANCHO LOS AMIGOS HB 226
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-401-8192
Practice Address - Fax:562-401-6678
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19794103G00000X
CA19794103TC0700X, 103T00000X, 103TB0200X, 103TR0400X, 103TA0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service