Provider Demographics
NPI:1760509665
Name:JONES, MARK ANTHONY (AA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:JONES
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 GRAND PRIX CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0102
Mailing Address - Country:US
Mailing Address - Phone:909-838-6083
Mailing Address - Fax:
Practice Address - Street 1:5526 GRAND PRIX CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0102
Practice Address - Country:US
Practice Address - Phone:909-838-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health