MEDICARE: MR. MARK DAVID JONES M.ED., 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	101YP2500X	Professional Counselor	831	OK

General Provider Information

NPI Number	:	1912130501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK DAVID JONES M.ED., LPC

Provider Business Mailing Address
First Line	:	4505 SE 48TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-3213
Country	:	US
Telephone Number	:	405-990-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 SE 48TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-3213
Country	:	US
Telephone Number	:	405-990-3057
Fax Number	:

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

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	08/28/2009

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