Provider Demographics
NPI:1851492508
Name:JONES, PHYLLIS LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LEE
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 1:216 RIO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3343
Mailing Address - Country:US
Mailing Address - Phone:972-506-7399
Mailing Address - Fax:
Practice Address - Street 1:1005 W JEFFERSON BLVD
Practice Address - Street 2:STE. 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5087
Practice Address - Country:US
Practice Address - Phone:214-941-1650
Practice Address - Fax:214-941-8008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0967671-01Medicaid