Provider Demographics
NPI:1952534307
Name:JONES, DARREN REED (PHD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:REED
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6213
Mailing Address - Country:US
Mailing Address - Phone:248-849-3441
Mailing Address - Fax:248-849-5389
Practice Address - Street 1:22250 PROVIDENCE DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48075-6213
Practice Address - Country:US
Practice Address - Phone:248-849-3441
Practice Address - Fax:248-849-5389
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012637390200000X
MI6301014632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program