MEDICARE: ALISA ANNE JONES CSW

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	1041C0700X	Clinical Social Worker	IC-1113	NV

General Provider Information

NPI Number	:	1518481712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA ANNE JONES CSW

Provider Business Mailing Address
First Line	:	2801 S VALLEY VIEW BLVD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0166
Country	:	US
Telephone Number	:	702-922-7015
Fax Number	:	702-922-6600

Provider Business Practice Location Address
First Line	:	7477 W LAKE MEAD BLVD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1027
Country	:	US
Telephone Number	:	702-344-0466
Fax Number	:

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

Provider Enumeration Date	:	07/29/2017
Last Update Date	:	04/14/2020

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