Provider Demographics
NPI:1215077573
Name:JONES, MARK (PHD , LMHP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD , LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3615
Mailing Address - Country:US
Mailing Address - Phone:402-669-4637
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:STE 430
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2987
Practice Address - Country:US
Practice Address - Phone:402-342-6197
Practice Address - Fax:402-342-6199
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85192OtherBLUE CROSS BLUE SHIELD