MEDICARE: KELBY ANDREW JONES LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC-21921	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LAC-7532T	OTHER	AZ	BOARD OF BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1053031021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELBY ANDREW JONES LAC

Provider Business Mailing Address
First Line	:	2127 W WINDOW ROCK DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1854
Country	:	US
Telephone Number	:	520-730-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2127 W WINDOW ROCK DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1854
Country	:	US
Telephone Number	:	520-730-6620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	11/25/2024

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Directions to “ KELBY ANDREW JONES LAC” Practice Location

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