MEDICARE: CAROLINE GRACE (JERNIGAN) JONES L.M.F.T.

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	106H00000X	Marriage & Family Therapist	1909	MN

General Provider Information

NPI Number	:	1780915348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRACE (JERNIGAN) JONES L.M.F.T.

Provider Business Mailing Address
First Line	:	1113 E FRANKLIN AVE
Second Line	:	SUITE 203
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2974
Country	:	US
Telephone Number	:	612-747-2121
Fax Number	:	612-729-7834

Provider Business Practice Location Address
First Line	:	1113 E FRANKLIN AVE
Second Line	:	SUITE 203
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2974
Country	:	US
Telephone Number	:	612-276-7052
Fax Number	:	612-729-7834

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

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	02/14/2013

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