Provider Demographics
NPI:1962540344
Name:JONES, RANDALL SCOTT (MED, CADC1)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:SCOTT
Last Name:JONES
Suffix:
Gender:M
Credentials:MED, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 PHIPPS CIR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1949
Mailing Address - Country:US
Mailing Address - Phone:503-566-3768
Mailing Address - Fax:
Practice Address - Street 1:3325 HAROLD DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1339
Practice Address - Country:US
Practice Address - Phone:503-363-2021
Practice Address - Fax:503-363-4820
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR061131101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061131OtherCADC1 CERTIFICATION
OR4835505OtherDRIVER'S LICENSE