Healthcare Provider Details

I. General information

NPI: 1407164247
Provider Name (Legal Business Name): ANTHONY ISAAC JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY # 8C
SPARKS NV
89431-5564
US

IV. Provider business mailing address

5802 MEADOW PARK DR
SPARKS NV
89436-7378
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax:
Mailing address:
  • Phone: 775-313-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: