Basic Information
| Provider Information | |||||||||
| NPI: | 1487024063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 N INGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712033933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185470887 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 STUBBS AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183258748 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2015 | ||||||||
| LastUpdateDate: | 07/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 4804 | LA | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 4804 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.