Provider Demographics
NPI:1588075246
Name:JONES, TERRY LYNN
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 24TH ST BLDG 8130
Mailing Address - Street 2:
Mailing Address - City:FORT GREGG ADAMS
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-1988
Mailing Address - Fax:
Practice Address - Street 1:402 W. 761ST TANK BATTALION AVENUE
Practice Address - Street 2:BLDG. 2255
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-1560
Practice Address - Fax:254-288-6474
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical