Healthcare Provider Details

I. General information

NPI: 1104388586
Provider Name (Legal Business Name): TIFFANY B JONES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 ROYAL AVE
MONROE LA
71201-5608
US

IV. Provider business mailing address

1410 ROYAL AVE
MONROE LA
71201-5608
US

V. Phone/Fax

Practice location:
  • Phone: 318-998-3511
  • Fax:
Mailing address:
  • Phone: 318-998-3511
  • 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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: