Provider Demographics
NPI:1134401839
Name:JONES, LORETTA A (BSW, BHRS)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:BSW, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3103
Mailing Address - Country:US
Mailing Address - Phone:918-557-1041
Mailing Address - Fax:918-681-1116
Practice Address - Street 1:502 E CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5535
Practice Address - Country:US
Practice Address - Phone:918-681-1113
Practice Address - Fax:918-681-1116
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker