Provider Demographics
NPI:1366950107
Name:JONES, CELIA ANN (LMHC)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:NM
Mailing Address - Zip Code:87527-0516
Mailing Address - Country:US
Mailing Address - Phone:505-579-0045
Mailing Address - Fax:
Practice Address - Street 1:224 CRUZ ALTA RD STE J
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5947
Practice Address - Country:US
Practice Address - Phone:575-737-5533
Practice Address - Fax:575-737-5533
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0204371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44582081Medicaid