Provider Demographics
NPI:1255647921
Name:JONES, SUSAN R (MS LCPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2825
Mailing Address - Country:US
Mailing Address - Phone:620-200-3401
Mailing Address - Fax:
Practice Address - Street 1:1714 E 30TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1262
Practice Address - Country:US
Practice Address - Phone:620-931-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional