Healthcare Provider Details

I. General information

NPI: 1285725135
Provider Name (Legal Business Name): RONALD RAY JONES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 BLUE LAKES BLVD N SUITE 104
TWIN FALLS ID
83301-3362
US

IV. Provider business mailing address

612 E 17TH ST
BURLEY ID
83318-2602
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-0407
  • Fax:
Mailing address:
  • Phone: 208-670-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-3000
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: