Basic Information
| Provider Information | |||||||||
| NPI: | 1457382780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6231 HIGHLAND PLACE WAY | ||||||||
| Address2: | STE 101 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652642400 | ||||||||
| FaxNumber: | 8655886406 | ||||||||
| Practice Location | |||||||||
| Address1: | 1128 E WEISGARBER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655790552 | ||||||||
| FaxNumber: | 8655791154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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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 | 103TC0700X | P0000873 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3582445 | 05 | TN | MEDICAID |