Provider Demographics
NPI:1295992691
Name:JONES, KEVIN A (MA, LP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COMO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1718
Mailing Address - Country:US
Mailing Address - Phone:651-334-0929
Mailing Address - Fax:
Practice Address - Street 1:2301 COMO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1718
Practice Address - Country:US
Practice Address - Phone:651-334-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN0161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical