=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871151050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARREN JONES LMFT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2019
-----------------------------------------------------
Last Update Date | 06/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 781 COLLEGE ST
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-742-2953
-----------------------------------------------------
Fax | 478-257-7914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 781 COLLEGE ST
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-742-2953
-----------------------------------------------------
Fax | 478-257-7914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
Name | MR. WARREN JONES
-----------------------------------------------------
Credential | M.DIV
-----------------------------------------------------
Telephone | 478-742-2953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------