Provider Demographics
NPI:1720799448
Name:JONES, BRYAN ARTHUR
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ARTHUR
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 1:18888 OUTER HWY 18 STE 208
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2315
Mailing Address - Country:US
Mailing Address - Phone:760-881-0070
Mailing Address - Fax:
Practice Address - Street 1:18888 OUTER HWY 18 STE 208
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2315
Practice Address - Country:US
Practice Address - Phone:760-881-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1424050421101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor