Provider Demographics
NPI:1811323371
Name:JONES, CHARYLL THAXTON (BHT)
Entity type:Individual
Prefix:MS
First Name:CHARYLL
Middle Name:THAXTON
Last Name:JONES
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1032
Mailing Address - Country:US
Mailing Address - Phone:727-209-0985
Mailing Address - Fax:727-209-0449
Practice Address - Street 1:9220 102ND AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-1032
Practice Address - Country:US
Practice Address - Phone:727-209-0985
Practice Address - Fax:727-209-0449
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor