Provider Demographics
NPI:1730565995
Name:JONES, JEREMY SCOTT (LPC, PCMHC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:SCOTT
Last Name:JONES
Suffix:
Gender:M
Credentials:LPC, PCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 LAS CIMBRAS CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1166
Mailing Address - Country:US
Mailing Address - Phone:503-744-7440
Mailing Address - Fax:541-248-1147
Practice Address - Street 1:2301 NW THURMAN ST STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2581
Practice Address - Country:US
Practice Address - Phone:503-744-7440
Practice Address - Fax:541-248-1147
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
ORC5359101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23026057Medicaid