Provider Demographics
NPI:1992251862
Name:JONES, SHAQUIL
Entity type:Individual
Prefix:
First Name:SHAQUIL
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 LA MESA AVE
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9210
Mailing Address - Country:US
Mailing Address - Phone:510-901-9583
Mailing Address - Fax:
Practice Address - Street 1:1170 INDUSTRIAL ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0734
Practice Address - Country:US
Practice Address - Phone:530-722-9957
Practice Address - Fax:530-722-9294
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA138859106H00000X
CA108984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health