Provider Demographics
NPI:1194806331
Name:JONES, FRED (CADCIII, LPC)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:CADCIII, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1021
Mailing Address - Country:US
Mailing Address - Phone:414-445-0997
Mailing Address - Fax:414-445-0989
Practice Address - Street 1:5303 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-445-0997
Practice Address - Fax:414-445-0989
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI151101YA0400X
WI3220-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3220-125OtherLPC
WI39736200Medicaid
WI151OtherCADCIII