Provider Demographics
NPI:1184112179
Name:JONES, TA TANISHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TA TANISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:6185 MAGNOLIA AVE # 224
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2524
Mailing Address - Country:US
Mailing Address - Phone:951-275-8500
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8712
Practice Address - Country:US
Practice Address - Phone:951-335-5858
Practice Address - Fax:951-335-5870
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30448103TC0700X
CAA042410916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)