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General NPI Number Information
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NPI Number | 1992253017
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Entity Type | Individual
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Provider Name | NICKOLAS JONES PHD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 920 ALDER AVE SUITE 207
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City | SUMNER
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State | WA
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Zip | 98390-1401
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Country | US
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Telephone | 253-470-6733
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Fax | 253-883-3985
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Provider Business Mailing Address
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Address Line | 920 ALDER AVE SUITE 207
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City | SUMNER
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State | WA
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Zip | 98390-1401
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Country | US
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Telephone | 253-470-6733
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Fax | 253-883-3985
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60692461
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License Number State | WA
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