Provider Demographics
NPI:1679142277
Name:JONES, CHANEL FORTIER (LMSW, MSM)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:FORTIER
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW, MSM
Other - Prefix:MS
Other - First Name:CHANEL
Other - Middle Name:
Other - Last Name:FORTIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8901 W 106TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5575
Mailing Address - Country:US
Mailing Address - Phone:913-998-1171
Mailing Address - Fax:
Practice Address - Street 1:8901 W 106TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5575
Practice Address - Country:US
Practice Address - Phone:913-998-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS121561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical