MEDICARE: MS. HOLLY LYNN 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	6801118115	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801101297	OTHER	MI	BOARD OF SOCIAL WORK

General Provider Information

NPI Number	:	1669990834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY LYNN JONES LMSW

Provider Business Mailing Address
First Line	:	4370 CHICAGO DR SW # 515
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-287-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 CHICAGO DR SW # 515
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-287-2283
Fax Number	:	616-585-0148

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

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	05/29/2024

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