MEDICARE: NICONA LORENE JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063691871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICONA LORENE JONES

Provider Business Mailing Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

Provider Business Practice Location Address
First Line	:	1200 W WALNUT ST
Second Line	:	SUITE 1400
City	:	ROGERS
State	:	AR
Zip	:	72756-3521
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	07/31/2017

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1134452071 — ALICIA RENEE FARMER LPC
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Directions to “ NICONA LORENE JONES ” Practice Location

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