Provider Demographics
NPI:1922655307
Name:JONES, MARTELL ANTHONY
Entity Type:Individual
Prefix:
First Name:MARTELL
Middle Name:ANTHONY
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 1:25011 WOODEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8464
Mailing Address - Country:US
Mailing Address - Phone:951-639-7171
Mailing Address - Fax:
Practice Address - Street 1:25011 WOODEN GATE DR STE 1800
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8464
Practice Address - Country:US
Practice Address - Phone:951-515-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY46384621103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst