Basic Information
| Provider Information | |||||||||
| NPI: | 1871569624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10025 WEST MARKHAM ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016635473 | ||||||||
| FaxNumber: | 5018011816 | ||||||||
| Practice Location | |||||||||
| Address1: | 3604 CENTRAL AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247111 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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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 | 101YM0800X | A0505036 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | P0802019 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1871569624 | 01 | AR | BCBS | OTHER | 1871569624 | 01 | AR | NOVA SYSTEMS | OTHER | 116399726 | 05 | AR | MEDICAID | 710401764 | 01 | AR | CORP HEALTH | OTHER | 1871569624 | 01 | AR | TRICARE - STANDARD | OTHER | 1871569624 | 01 | AR | UNITY MGED MH (A/K/A ST JOHN'S MERCY HEALTH) | OTHER | 08050011000 | 01 | AR | QUAL-CHOICE | OTHER | 2565557 | 01 | AR | CIGNA | OTHER | 420017 | 01 | AR | MHN | OTHER |