Provider Demographics
NPI:1902159197
Name:JONES, TERI LYNN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:707 W MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2943
Mailing Address - Country:US
Mailing Address - Phone:313-938-1259
Mailing Address - Fax:313-831-2608
Practice Address - Street 1:707 W MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2943
Practice Address - Country:US
Practice Address - Phone:313-938-1259
Practice Address - Fax:313-831-2608
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801087172Medicaid