Provider Demographics
NPI:1821708009
Name:JONES, TIMOTHY D SR
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:JONES
Suffix:SR
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 1:15093 SCOTTSDALE LN
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5804
Mailing Address - Country:US
Mailing Address - Phone:405-249-6507
Mailing Address - Fax:
Practice Address - Street 1:3611 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4962
Practice Address - Country:US
Practice Address - Phone:405-249-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor