MEDICARE: TANISHA ALICE JONES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1972816668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA ALICE JONES

Provider Business Mailing Address
First Line	:	2263 W ADAMS BLVD APT C208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-2023
Country	:	US
Telephone Number	:	323-766-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2263 W ADAMS BLVD APT C208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-2023
Country	:	US
Telephone Number	:	323-766-9003
Fax Number	:

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

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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