Provider Demographics
NPI:1013528223
Name:JONES, MACEY LYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MACEY
Middle Name:LYN
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CHESTNUT ST STE 225
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3329
Mailing Address - Country:US
Mailing Address - Phone:217-202-9506
Mailing Address - Fax:217-355-1255
Practice Address - Street 1:100 N CHESTNUT ST STE 225
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3329
Practice Address - Country:US
Practice Address - Phone:217-202-9506
Practice Address - Fax:217-355-1255
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490224321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical