Basic Information
| Provider Information | |||||||||
| NPI: | 1427132281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | SLETTIE | ||||||||
| MiddleName: | MORENTA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3711 COUNTRY CLUB DR | ||||||||
| Address2: | #5 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908073169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624926411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11721 TELEGRAPH RD | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629498455 | ||||||||
| FaxNumber: | 5629429467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS17135 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.