Healthcare Provider Details

I. General information

NPI: 1154002137
Provider Name (Legal Business Name): GEORDEN JONES PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 01/31/2024
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WASHINGTON ST SUITE 100
ANN ARBOR MI
48104
US

IV. Provider business mailing address

500 E WASHINGTON ST SUITE 100
ANN ARBOR MI
48104
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-7853
  • Fax: 734-764-8128
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301019296
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301019296
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: