Provider Demographics
NPI:1336927185
Name:JONES, GWENDALYNN BETH
Entity Type:Individual
Prefix:
First Name:GWENDALYNN
Middle Name:BETH
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OAKRIDGE DR APT 211
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2006
Mailing Address - Country:US
Mailing Address - Phone:405-694-3884
Mailing Address - Fax:
Practice Address - Street 1:201 OAKRIDGE DR APT 211
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2006
Practice Address - Country:US
Practice Address - Phone:405-694-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service