Healthcare Provider Details

I. General information

NPI: 1245852532
Provider Name (Legal Business Name): TY'ASIA L JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 PLEASANT LAKE BLVD APT U2
PARMA OH
44130-7495
US

IV. Provider business mailing address

9834 PLEASANT LAKE BLVD APT U2
PARMA OH
44130-7495
US

V. Phone/Fax

Practice location:
  • Phone: 330-592-5843
  • Fax:
Mailing address:
  • Phone: 347-292-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: