Healthcare Provider Details

I. General information

NPI: 1336682467
Provider Name (Legal Business Name): MICHAEL R JONES THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

PO BOX 32145
SANTA FE NM
87594-2145
US

V. Phone/Fax

Practice location:
  • Phone: 505-985-5644
  • Fax:
Mailing address:
  • Phone: 505-985-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09546
License Number StateNM

VIII. Authorized Official

Name: MICHAEL RUTHERFORD JONES
Title or Position: SOLE PROPRIETOR
Credential: PH.D., L.C.S.W.
Phone: 505-985-5644