Provider Demographics
NPI:1295092310
Name:JONES PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:JONES PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:810-966-1972
Mailing Address - Street 1:805 SUPERIOR ST
Mailing Address - Street 2:STE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3771
Mailing Address - Country:US
Mailing Address - Phone:810-966-1972
Mailing Address - Fax:810-966-1973
Practice Address - Street 1:805 SUPERIOR ST
Practice Address - Street 2:STE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3771
Practice Address - Country:US
Practice Address - Phone:810-966-1972
Practice Address - Fax:810-966-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010518342084P0800X
MI6301011246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty