MEDICARE: MS. TARA JONES LMSW

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	1041C0700X	Clinical Social Worker	10691	SC

General Provider Information

NPI Number	:	1336547496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA JONES LMSW

Provider Business Mailing Address
First Line	:	1410 HIGHMARKET ST
Second Line	:	PMB #203
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-3253
Country	:	US
Telephone Number	:	843-240-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 HIGHMARKET ST
Second Line	:	PMB #203
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-3253
Country	:	US
Telephone Number	:	843-240-8272
Fax Number	:

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

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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