Provider Demographics
NPI:1831370592
Name:JONES, ERNEST GRANT
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GRANT
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 1:1864 S KENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2323
Mailing Address - Country:US
Mailing Address - Phone:417-869-8400
Mailing Address - Fax:417-869-8401
Practice Address - Street 1:1864 S KENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2323
Practice Address - Country:US
Practice Address - Phone:417-869-8400
Practice Address - Fax:417-869-8401
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist