Basic Information
| Provider Information | |||||||||
| NPI: | 1841425626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPA, LCMHC, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 468 PINE AVE | ||||||||
| Address2: | |||||||||
| City: | PACIFIC GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939503440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169062440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 468 PINE AVE | ||||||||
| Address2: | |||||||||
| City: | PACIFIC GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939503440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169062440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 06/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 3888 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 101YM0800X | 9376 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6107650 | 05 | NC | MEDICAID |