Healthcare Provider Details

I. General information

NPI: 1154511665
Provider Name (Legal Business Name): JILL LYNN JONES MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 STRAITS RD
NEW HAMPTON NH
03256-4714
US

IV. Provider business mailing address

153 STRAITS RD
NEW HAMPTON NH
03256-4714
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-8996
  • Fax:
Mailing address:
  • Phone: 603-224-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: