Healthcare Provider Details

I. General information

NPI: 1457320350
Provider Name (Legal Business Name): DEPARTMENT OF THE ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 560 BOX 907
OKINAWA APO AP
96376
JP

IV. Provider business mailing address

PSC 560 BOX 907
OKINAWA APO AP
96376
JP

V. Phone/Fax

Practice location:
  • Phone: 81986444112
  • Fax:
Mailing address:
  • Phone: 81986444112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12429
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID E. JONES
Title or Position: HEAD OF SUBSTANCE ABUSE DEPARTMENT
Credential: PSYCHOLOGIST
Phone: 81986450356