MEDICARE: DR. MARY BETH JONES PH.D., LPC

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	1620	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	721240010	OTHER	LA	S CORPORATION

General Provider Information

NPI Number	:	1902027493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH JONES PH.D., LPC

Provider Business Mailing Address
First Line	:	3018 OLD MINDEN RD STE 1206
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2543
Country	:	US
Telephone Number	:	318-517-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 OLD MINDEN RD STE 1206
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2543
Country	:	US
Telephone Number	:	318-517-1644
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	05/12/2014

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