Healthcare Provider Details

I. General information

NPI: 1295464071
Provider Name (Legal Business Name): MELANIE GABRIELLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8198 S JOG RD STE 201
BOYNTON BEACH FL
33472-6903
US

IV. Provider business mailing address

500 FAIRWAY DR STE 102
DEERFIELD BEACH FL
33441-1817
US

V. Phone/Fax

Practice location:
  • Phone: 561-810-6631
  • Fax:
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: