Provider Demographics
NPI:1295162618
Name:JONES, DUSTY (DUSTY JONES)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DUSTY JONES
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:995 MIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:995 MIDDLE STREET
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-210-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst