Healthcare Provider Details

I. General information

NPI: 1962070763
Provider Name (Legal Business Name): ROYCE LASHON JONES LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 BAXTER AVE STE 201
LOUISVILLE KY
40204-1177
US

IV. Provider business mailing address

451 BAXTER AVE STE 201
LOUISVILLE KY
40204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 502-383-2969
  • Fax: 502-309-2970
Mailing address:
  • Phone: 502-383-2969
  • Fax: 502-309-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401019428
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number304393
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: