MEDICARE: MR. TOMMY LEE JONES II B.S PSYCH, M.A., M.S

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

General Provider Information

NPI Number	:	1326570185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMMY LEE JONES II B.S PSYCH, M.A., M.S

Provider Business Mailing Address
First Line	:	609 PINEVIEW LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6506
Country	:	US
Telephone Number	:	817-932-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 PINEVIEW LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6506
Country	:	US
Telephone Number	:	817-516-9100
Fax Number	:

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

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	03/31/2017

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