Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401001951 | MI |
Y | 103TC1900X | Counseling Psychologist | 6401001951 | MI |
NPI | 1003154089 |
---|---|
Provider Name | Dr. Marvin Warren Jones |
First Address | Saint Clair, MI 48079-3529 |
Second Address | Saint Clair, MI 48079-3529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2013 |
Last Update Date | 25/01/2013 |