Healthcare Provider Details

I. General information

NPI: 1013692995
Provider Name (Legal Business Name): AMY M JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 LYNDALE DR
ODESSA TX
79762-4632
US

IV. Provider business mailing address

1500 ENGLEWOOD LN
ODESSA TX
79761-3234
US

V. Phone/Fax

Practice location:
  • Phone: 432-413-8504
  • Fax:
Mailing address:
  • Phone: 432-413-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number73170
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87120
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7005348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: