=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437800778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PSYCHOTHERAPY STUDIO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2022
-----------------------------------------------------
Last Update Date | 01/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 CONNECTICUT AVE NW APT 436
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-856-0841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4601 N PARK AVE APT 1817
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-856-0841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMIE KEATON JONES
-----------------------------------------------------
Credential | LICSW, PHD
-----------------------------------------------------
Telephone | 917-856-0841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------