Provider Demographics
NPI:1326499120
Name:JONES, JOHN PAUL (LCPC - 9219 (ID))
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:JONES
Suffix:
Gender:M
Credentials:LCPC - 9219 (ID)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E 5TH N STE 280
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2749
Mailing Address - Country:US
Mailing Address - Phone:208-580-8525
Mailing Address - Fax:
Practice Address - Street 1:280 E 5TH N STE 280
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2749
Practice Address - Country:US
Practice Address - Phone:208-591-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLCMHC-13656427-6004101YM0800X
IDLCPC-9219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184880924Medicaid