Provider Demographics
NPI:1447702857
Name:JONES, RICHARD (MDIV, LMHC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MDIV, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10014 NORTHWIND DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9339
Mailing Address - Country:US
Mailing Address - Phone:317-408-8880
Mailing Address - Fax:
Practice Address - Street 1:819 EAST 64TH STREET
Practice Address - Street 2:#216
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-6610
Practice Address - Country:US
Practice Address - Phone:317-408-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002124A101Y00000X, 101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral