Healthcare Provider Details

I. General information

NPI: 1639085152
Provider Name (Legal Business Name): NICOLE C JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 PRO MED LN
CARMEL IN
46032-5327
US

IV. Provider business mailing address

2204 N JANNEY AVE
MUNCIE IN
47304-2335
US

V. Phone/Fax

Practice location:
  • Phone: 317-836-0569
  • Fax:
Mailing address:
  • Phone: 765-669-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: