Healthcare Provider Details

I. General information

NPI: 1235649807
Provider Name (Legal Business Name): TEENA JONES,LICSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 ROYAL AVE SPC 27
EUGENE OR
97402-6820
US

IV. Provider business mailing address

4736 ROYAL AVE PMB 109169
EUGENE OR
97402
US

V. Phone/Fax

Practice location:
  • Phone: 360-232-3906
  • Fax: 888-211-2226
Mailing address:
  • Phone: 360-232-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHRISTINE JONES
Title or Position: OWNER/MANAGER
Credential: LICSW
Phone: 360-232-3906