Provider Demographics
NPI:1851676266
Name:JONES, MATTHEW TOMMY
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TOMMY
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 1:4405 SPIVA DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4427
Mailing Address - Country:US
Mailing Address - Phone:918-351-4609
Mailing Address - Fax:
Practice Address - Street 1:4405 SPIVA DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4427
Practice Address - Country:US
Practice Address - Phone:918-351-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health