Provider Demographics
NPI:1063433639
Name:JONES, PHILIP A (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 BURBANK BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6612
Mailing Address - Country:US
Mailing Address - Phone:818-884-8977
Mailing Address - Fax:818-346-8819
Practice Address - Street 1:18401 BURBANK BLVD STE 229
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6612
Practice Address - Country:US
Practice Address - Phone:818-884-8977
Practice Address - Fax:818-346-8819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PY5205Medicare ID - Type Unspecified