Provider Demographics
NPI:1891157137
Name:JAYNES, THOMAS (CADC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JAYNES
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1026
Mailing Address - Country:US
Mailing Address - Phone:712-258-4776
Mailing Address - Fax:712-224-2169
Practice Address - Street 1:1800 GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1026
Practice Address - Country:US
Practice Address - Phone:712-258-4776
Practice Address - Fax:712-224-2169
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)