Provider Demographics
NPI:1073344388
Name:JONES, KEISHA (PHD)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:WILLIAMS
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:610 SCOOTER WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4605
Mailing Address - Country:US
Mailing Address - Phone:424-303-1100
Mailing Address - Fax:
Practice Address - Street 1:610 SCOOTER WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4605
Practice Address - Country:US
Practice Address - Phone:424-303-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool