Provider Demographics
NPI:1699916593
Name:JONES, TARYN CELESTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:CELESTE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TARYN
Other - Middle Name:C
Other - Last Name:DOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1041 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2712
Mailing Address - Country:US
Mailing Address - Phone:850-389-8489
Mailing Address - Fax:844-377-9201
Practice Address - Street 1:1041 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2712
Practice Address - Country:US
Practice Address - Phone:850-389-8489
Practice Address - Fax:844-377-9201
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10808171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013322600Medicaid