Doctor Name: | BRUCE JONES |
NPI Number: | 1134532922 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 87001537A |
Business Practice Address: | 1209 E 35th Ave Apt 2c Griffith, IN - 463191409 |
Business Phone Number: | 2199238486 |
Business Fax Number: | |
Mailing Address: | 1209 E 35th Ave Apt 2c, GRIFFITH |
State: | IN |
Postal Code: | 463191409 |
Phone Number: | 2199238486 |
Fax Number: | |
NPI Enumeration Date: | 06/09/2014 |
NPI Last Update Date: | 06/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 87001537A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |