Provider Demographics
NPI:1134906621
Name:JONES, BRENNA (LMSW)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 STOCKHAM BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1282
Mailing Address - Country:US
Mailing Address - Phone:208-915-6337
Mailing Address - Fax:
Practice Address - Street 1:211 S WOODRUFF AVE STE A3
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4865
Practice Address - Country:US
Practice Address - Phone:208-524-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-426391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical