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General NPI Number Information
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NPI Number | 1518734359
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Entity Type | Individual
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Provider Name | JENNELL JONES B.A., CBHCM-P
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 8920 TRAFFORD DR APT 2331
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City | MELBOURNE
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State | FL
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Zip | 32940-8345
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Country | US
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Telephone | 321-557-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 TRAFFORD DR APT 2331
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City | MELBOURNE
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State | FL
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Zip | 32940-8345
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Country | US
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Telephone | 321-557-4774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CBHCM.0106227-P
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License Number State | FL
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