Provider Demographics
NPI:1720340250
Name:JONES, RODERICK
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 SEPULVEDA BLVD
Mailing Address - Street 2:APT 116
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4435
Mailing Address - Country:US
Mailing Address - Phone:818-849-6086
Mailing Address - Fax:
Practice Address - Street 1:6833 SEPULVEDA BLVD
Practice Address - Street 2:APT. #116
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4435
Practice Address - Country:US
Practice Address - Phone:818-849-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health