Healthcare Provider Details

I. General information

NPI: 1386197028
Provider Name (Legal Business Name): MR. KENDALL JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KENDALL JONES LMHC

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 SE MILL PLAIN BLVD STE 311A
VANCOUVER WA
98684-5091
US

IV. Provider business mailing address

15640 NE FOURTH PLAIN BLVD STE 106 PMB 11
VANCOUVER WA
98682-5141
US

V. Phone/Fax

Practice location:
  • Phone: 360-524-4711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61169398
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH61169398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: