Healthcare Provider Details

I. General information

NPI: 1164477386
Provider Name (Legal Business Name): SHANE JONES & ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 NW TOPEKA BLVD SUITE D
TOPEKA KS
66617-1143
US

IV. Provider business mailing address

2704 NW TOPEKA BLVD SUITE D
TOPEKA KS
66617-1143
US

V. Phone/Fax

Practice location:
  • Phone: 785-266-7732
  • Fax: 702-925-7052
Mailing address:
  • Phone: 785-266-7732
  • Fax: 702-925-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number000746
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00938
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001146
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000257
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00732
License Number StateKS

VIII. Authorized Official

Name: SHANE JONES
Title or Position: OFFICE MANAGER
Credential: LSCSW
Phone: 785-266-7732