Healthcare Provider Details

I. General information

NPI: 1962773127
Provider Name (Legal Business Name): THOMAS JONES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W OWENS AVE
LAS VEGAS NV
89106-2516
US

IV. Provider business mailing address

916 W OWENS AVE
LAS VEGAS NV
89106-2516
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax: 702-791-9314
Mailing address:
  • Phone: 702-791-9000
  • Fax: 702-791-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6182-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: