Provider Demographics
NPI:1053031021
Name:JONES, KELBY ANDREW (LAC)
Entity type:Individual
Prefix:
First Name:KELBY
Middle Name:ANDREW
Last Name:JONES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 W WINDOW ROCK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1854
Mailing Address - Country:US
Mailing Address - Phone:520-730-6620
Mailing Address - Fax:
Practice Address - Street 1:2127 W WINDOW ROCK DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1854
Practice Address - Country:US
Practice Address - Phone:520-730-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-7532TOtherBOARD OF BEHAVIORAL HEALTH