=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568704047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CARMELLA PATRICE JONES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3402 GARROTT ST APT. 10
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-4472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-598-7313
-----------------------------------------------------
Fax | 281-741-1788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3402 GARROTT ST APT. 10
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-4472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-598-7313
-----------------------------------------------------
Fax | 281-741-1788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------