Provider Demographics
NPI:1518734359
Name:JONES, JENNELL (BA, CBHCM-P)
Entity type:Individual
Prefix:
First Name:JENNELL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:BA, CBHCM-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 TRAFFORD DR APT 2331
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8345
Mailing Address - Country:US
Mailing Address - Phone:321-557-4774
Mailing Address - Fax:
Practice Address - Street 1:8920 TRAFFORD DR APT 2331
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8345
Practice Address - Country:US
Practice Address - Phone:321-557-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0106227-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator