Provider Demographics
NPI:1770807091
Name:JONES, GARY A JR (BS, CSTCM, PSRS)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:JONES
Suffix:JR
Gender:M
Credentials:BS, CSTCM, PSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-7010
Mailing Address - Country:US
Mailing Address - Phone:405-923-4395
Mailing Address - Fax:
Practice Address - Street 1:1908 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-7010
Practice Address - Country:US
Practice Address - Phone:405-923-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123000AMedicaid