Provider Demographics
NPI:1790108942
Name:JONES, QUINTON
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:111 ARROWHEAD DRIVE
Practice Address - Street 2:ADOLESCENT TRANSITIONAL LIVING CENTER
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075
Practice Address - Country:US
Practice Address - Phone:405-331-2300
Practice Address - Fax:405-331-2302
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1588968275Medicaid