Provider Demographics
NPI:1588783120
Name:JONES, ALISA DIANE (FRA)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:DIANE
Last Name:JONES
Suffix:
Gender:F
Credentials:FRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 ALDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2733
Mailing Address - Country:US
Mailing Address - Phone:541-688-9723
Mailing Address - Fax:
Practice Address - Street 1:576 OLIVE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2642
Practice Address - Country:US
Practice Address - Phone:541-344-7303
Practice Address - Fax:541-686-6283
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health