Basic Information
| Provider Information | |||||||||
| NPI: | 1912409228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 E OXFORD DR | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852832345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802348893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 438 W. SEED FARM ROAD | ||||||||
| Address2: | |||||||||
| City: | SACATON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205623321 | ||||||||
| FaxNumber: | 6025281341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2018 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 13454 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.