Healthcare Provider Details

I. General information

NPI: 1114610656
Provider Name (Legal Business Name): MELANIE S JONES ED.D., PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE JONES OWEN ED.D., PSY.D.

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 LAKE EARL DR
CRESCENT CITY CA
95532-9715
US

IV. Provider business mailing address

PO BOX 1406
BROOKINGS OR
97415-0128
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-1000
  • Fax:
Mailing address:
  • Phone: 907-215-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94027308
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94027308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: