Provider Demographics
NPI:1902027493
Name:JONES, MARY BETH (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:MICKEY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:3018 OLD MINDEN RD STE 1206
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2543
Mailing Address - Country:US
Mailing Address - Phone:318-517-1644
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD STE 1206
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2543
Practice Address - Country:US
Practice Address - Phone:318-517-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721240010OtherS CORPORATION