MEDICARE: MR. GARY A JONES JR. B.S., CSTCM, PSRS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770807091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY A JONES JR. B.S., CSTCM, PSRS

Provider Business Mailing Address
First Line	:	1908 NE 52ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7010
Country	:	US
Telephone Number	:	405-923-4395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 NE 52ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-7010
Country	:	US
Telephone Number	:	405-923-4395
Fax Number	:

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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