Provider Demographics
NPI:1669210639
Name:JONES, JASON MATTHEW (MED, LPC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:JONES
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3966
Mailing Address - Country:US
Mailing Address - Phone:304-792-9405
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3966
Practice Address - Country:US
Practice Address - Phone:304-792-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2816101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor