Healthcare Provider Details

I. General information

NPI: 1609405976
Provider Name (Legal Business Name): TIA MARIE JONES BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIA MARIE ALLISON

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 SOUTH AVE
BOARDMAN OH
44512-6434
US

IV. Provider business mailing address

3580 INSPIRATION DR
COLORADO SPRINGS CO
80917-2717
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-9843
  • Fax:
Mailing address:
  • Phone: 330-501-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number474455
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70020
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: