MEDICARE: KEVIN JONES LPC

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	PRC14869	DC

General Provider Information

NPI Number	:	1356876882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN JONES LPC

Provider Business Mailing Address
First Line	:	4091 SILVER PARK TER
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-3047
Country	:	US
Telephone Number	:	202-246-2855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4091 SILVER PARK TER
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-3047
Country	:	US
Telephone Number	:	202-246-2855
Fax Number	:

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

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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