Provider Demographics
NPI:1174811061
Name:JONES, GWENDOLYN AILIVE (LCPC)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:AILIVE
Last Name:JONES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:EMIGRANT
Mailing Address - State:MT
Mailing Address - Zip Code:59027-0211
Mailing Address - Country:US
Mailing Address - Phone:425-213-4377
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6241
Practice Address - Country:US
Practice Address - Phone:425-213-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-4704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health