Provider Demographics
NPI:1851815559
Name:JONES, BRUCE THOMAS (LSW, LCDC III, NCGC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:THOMAS
Last Name:JONES
Suffix:
Gender:M
Credentials:LSW, LCDC III, NCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 ALUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1708
Mailing Address - Country:US
Mailing Address - Phone:614-324-5413
Mailing Address - Fax:
Practice Address - Street 1:1430 S HIGH ST FL 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1045
Practice Address - Country:US
Practice Address - Phone:614-324-5413
Practice Address - Fax:614-324-5413
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS31038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker