Provider Demographics
NPI:1174403943
Name:JONES, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 TELFORD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3722
Mailing Address - Country:US
Mailing Address - Phone:317-503-1296
Mailing Address - Fax:317-810-1439
Practice Address - Street 1:12354 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5807
Practice Address - Country:US
Practice Address - Phone:317-503-1296
Practice Address - Fax:317-810-1439
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22-199896106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician