Healthcare Provider Details

I. General information

NPI: 1295092310
Provider Name (Legal Business Name): JONES PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SUPERIOR ST STE A
PORT HURON MI
48060-3771
US

IV. Provider business mailing address

805 SUPERIOR ST STE A
PORT HURON MI
48060-3771
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-1972
  • Fax: 810-966-1973
Mailing address:
  • Phone: 810-966-1972
  • Fax: 810-966-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301011246
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301051834
License Number StateMI

VIII. Authorized Official

Name: MARK STEPHEN JONES
Title or Position: OWNER
Credential: LLP
Phone: 810-966-1972