Provider Demographics
NPI:1528481017
Name:JONES, JENNESS CANITA (MA)
Entity type:Individual
Prefix:
First Name:JENNESS
Middle Name:CANITA
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 OLD BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-0241
Mailing Address - Country:US
Mailing Address - Phone:850-766-4990
Mailing Address - Fax:843-454-0635
Practice Address - Street 1:148 OLD BETHEL RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-0241
Practice Address - Country:US
Practice Address - Phone:850-766-4990
Practice Address - Fax:843-454-0635
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC3343Medicare PIN