Healthcare Provider Details

I. General information

NPI: 1568703882
Provider Name (Legal Business Name): HAROLD G JONES II LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SPRING VALLEY DR
WINCHESTER KY
40391-9650
US

IV. Provider business mailing address

PO BOX 4501
WINCHESTER KY
40392-4501
US

V. Phone/Fax

Practice location:
  • Phone: 859-404-6742
  • Fax:
Mailing address:
  • Phone: 859-404-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number285755
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number285755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: