=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811704661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARYL JONES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3611 ATASCOCITA ELM DR
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396-5074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-385-5830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3611 ATASCOCITA ELM DR
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77396-5074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-385-5830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DARYL E JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-877-5143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------