Provider Demographics
NPI:1992253017
Name:JONES, NICKOLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ALDER AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1401
Mailing Address - Country:US
Mailing Address - Phone:253-470-6733
Mailing Address - Fax:253-883-3985
Practice Address - Street 1:920 ALDER AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1401
Practice Address - Country:US
Practice Address - Phone:253-470-6733
Practice Address - Fax:253-883-3985
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60692461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical