Healthcare Provider Details

I. General information

NPI: 1487381646
Provider Name (Legal Business Name): MICHAEL C JONES PSB94029649
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 12TH ST STE 325
OAKLAND CA
94607-4489
US

IV. Provider business mailing address

52 SKYWAY LN
OAKLAND CA
94619-3628
US

V. Phone/Fax

Practice location:
  • Phone: 510-338-3325
  • Fax:
Mailing address:
  • Phone: 949-412-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94029649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: