Provider Demographics
NPI:1912130501
Name:JONES, MARK DAVID (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 SE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-3213
Mailing Address - Country:US
Mailing Address - Phone:405-990-3057
Mailing Address - Fax:
Practice Address - Street 1:4505 SE 48TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-3213
Practice Address - Country:US
Practice Address - Phone:405-990-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional