Provider Demographics
NPI:1588600266
Name:JONES, BRYAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 REDLAND MESA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3536
Mailing Address - Country:US
Mailing Address - Phone:210-414-8439
Mailing Address - Fax:
Practice Address - Street 1:2415 REDLAND MESA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3536
Practice Address - Country:US
Practice Address - Phone:210-414-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323351041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149799201Medicare ID - Type UnspecifiedTPI NO
P50237Medicare UPIN
TX83536WMedicare ID - Type UnspecifiedMEDICARE NO