Provider Demographics
NPI:1801137617
Name:JONES, DEMETHRA L (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:
First Name:DEMETHRA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10648 HURON ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4045
Mailing Address - Country:US
Mailing Address - Phone:270-564-7925
Mailing Address - Fax:
Practice Address - Street 1:10648 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4045
Practice Address - Country:US
Practice Address - Phone:270-564-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYJ98176761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health