Provider Demographics
NPI:1790135531
Name:JONES, MARIAH ELISHA SHEPHERD (LPC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:ELISHA SHEPHERD
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-2528
Mailing Address - Country:US
Mailing Address - Phone:334-552-1800
Mailing Address - Fax:
Practice Address - Street 1:408 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-2528
Practice Address - Country:US
Practice Address - Phone:334-552-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5217101YM0800X
TN390200000X
AL05381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program