Provider Demographics
NPI:1699916460
Name:JONES, ELAINE B (MED)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-3533
Mailing Address - Country:US
Mailing Address - Phone:512-393-8875
Mailing Address - Fax:
Practice Address - Street 1:205 CHEATHAM ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6859
Practice Address - Country:US
Practice Address - Phone:512-393-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1560591-01Medicaid