Provider Demographics
NPI:1265719496
Name:JONES, TAMARA DEVON (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DEVON
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 1:1910 NONCONNAH BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2113
Mailing Address - Country:US
Mailing Address - Phone:901-346-1270
Mailing Address - Fax:901-346-1271
Practice Address - Street 1:1910 NONCONNAH BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2113
Practice Address - Country:US
Practice Address - Phone:901-346-1270
Practice Address - Fax:901-346-1271
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000054221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20-3858944Medicaid