Basic Information
| Provider Information | |||||||||
| NPI: | 1114544814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LATASHA | ||||||||
| MiddleName: | YVETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12531 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937782531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592467000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 412 F ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937063409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594986988 | ||||||||
| FaxNumber: | 5594856548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2020 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 71120 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 107610 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.