Healthcare Provider Details

I. General information

NPI: 1306349592
Provider Name (Legal Business Name): ALISA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ARBOR CT
WHEELING IL
60090-3167
US

IV. Provider business mailing address

185 ARBOR CT
WHEELING IL
60090-3167
US

V. Phone/Fax

Practice location:
  • Phone: 224-762-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: