Basic Information
Provider Information
NPI: 1730502592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JOAN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: P.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1115 BETHEL RD
Address2: WELLSPRING COUNSELING
City: COLUMBUS
State: OH
PostalCode: 432202690
CountryCode: US
TelephoneNumber: 6145380353
FaxNumber: 6144293219
Practice Location
Address1: 1115 BETHEL RD
Address2: WELLSPRING COUNSELING
City: COLUMBUS
State: OH
PostalCode: 432202690
CountryCode: US
TelephoneNumber: 6145380353
FaxNumber: 6144293219
Other Information
ProviderEnumerationDate: 01/30/2014
LastUpdateDate: 01/30/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XC. 1200574OHY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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