Provider Demographics
NPI:1124478276
Name:JONES, BEVERLY MARCUS
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MARCUS
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:MARCUS
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4009 WOODCREST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2333
Mailing Address - Country:US
Mailing Address - Phone:337-309-8564
Mailing Address - Fax:
Practice Address - Street 1:2400 MERGANSER ST
Practice Address - Street 2:2400 MERGANZER STREET
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-6898
Practice Address - Country:US
Practice Address - Phone:337-433-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health