Provider Demographics
NPI:1558636811
Name:JONES, MARIO LORENZO
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:LORENZO
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 W OWENS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2452
Mailing Address - Country:US
Mailing Address - Phone:702-877-9850
Mailing Address - Fax:702-877-9870
Practice Address - Street 1:1240 W OWENS AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2452
Practice Address - Country:US
Practice Address - Phone:702-877-9850
Practice Address - Fax:702-877-9870
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health