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NPI Code Detail

MEDICARE: MR. GEORGE JONES III LCCD

MEDICARE: MR. GEORGE JONES III LCCD
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
1101YA0400XAddiction (Substance Use Disorder) Counselor7778TX

General Provider Information

NPI Number : 1699045559
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE JONES III LCCD
Provider Business Mailing Address
First Line : PO BOX 6800
Second Line :
City : LONGVIEW
State : TX
Zip : 75608-6800
Country : US
Telephone Number : 903-758-2471
Fax Number : 903-234-1639
Provider Business Practice Location Address
First Line : 950 N 4TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5436
Country : US
Telephone Number : 903-758-0596
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2012
Last Update Date : 02/20/2025

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