Healthcare Provider Details

I. General information

NPI: 1588151708
Provider Name (Legal Business Name): HEATHER MAE-EARSULA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N D ST
SAN BERNARDINO CA
92410
US

IV. Provider business mailing address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-0840
  • Fax: 909-885-6852
Mailing address:
  • Phone: 909-884-0840
  • Fax: 909-885-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: