Provider Demographics
NPI:1457942120
Name:JONES-MARSH, LATONYA ELIZABETH (RBT)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:ELIZABETH
Last Name:JONES-MARSH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3508
Mailing Address - Country:US
Mailing Address - Phone:731-435-9828
Mailing Address - Fax:
Practice Address - Street 1:19 BRYANT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3508
Practice Address - Country:US
Practice Address - Phone:731-435-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB540474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7346243588OtherVA