Provider Demographics
NPI:1154535417
Name:JONES, KENNETH B (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
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 1:754 TEALWOOD LN.
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6333
Mailing Address - Country:US
Mailing Address - Phone:901-292-8074
Mailing Address - Fax:901-507-7929
Practice Address - Street 1:310 MID-CONTINENT PLAZA
Practice Address - Street 2:SUITE 606
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:901-292-8074
Practice Address - Fax:901-507-7929
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-17P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical