Provider Demographics
NPI:1861006587
Name:DR MICHAEL JONES PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DR MICHAEL JONES PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, HSPP
Authorized Official - Phone:317-778-8525
Mailing Address - Street 1:5219 N COLLEGE AVE APT 702
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3182
Mailing Address - Country:US
Mailing Address - Phone:317-778-8525
Mailing Address - Fax:317-495-6401
Practice Address - Street 1:8510 EVERGREEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2338
Practice Address - Country:US
Practice Address - Phone:317-778-8525
Practice Address - Fax:317-495-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty