MEDICARE: MS. CAROL JEAN JONES Q.M.H.P

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1942385547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL JEAN JONES Q.M.H.P

Provider Business Mailing Address
First Line	:	3255 SAN PABLO AVE APT 417
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-4363
Country	:	US
Telephone Number	:	415-424-7586
Fax Number	:	415-499-3080

Provider Business Practice Location Address
First Line	:	161 MITCHELL BLVD
Second Line	:	STE. #101
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2068
Country	:	US
Telephone Number	:	415-507-2824
Fax Number	:	415-499-3080

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/21/2022

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