MEDICARE: TERESA JONES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1073973871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA JONES

Provider Business Mailing Address
First Line	:	225 S RIO VISTA ST APT 98
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-3954
Country	:	US
Telephone Number	:	909-252-1433
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S RIO VISTA ST APT 98
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-3954
Country	:	US
Telephone Number	:	909-252-1433
Fax Number	:

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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Directions to “ TERESA JONES ” Practice Location

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