Provider Demographics
NPI:1841910411
Name:JONES, TINA KATHLEEN (APCC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:KATHLEEN
Last Name:JONES
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 S OREGON ST # 397
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3446
Mailing Address - Country:US
Mailing Address - Phone:530-842-3455
Mailing Address - Fax:530-842-7917
Practice Address - Street 1:1833 S OREGON ST # 397
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3446
Practice Address - Country:US
Practice Address - Phone:530-842-3455
Practice Address - Fax:530-842-7917
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC12242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689794190Medicaid