Provider Demographics
NPI:1922673136
Name:JONES, ANDREW SEAN (MA, PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SEAN
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16255 VENTURA BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2317
Mailing Address - Country:US
Mailing Address - Phone:801-935-4171
Mailing Address - Fax:704-838-1541
Practice Address - Street 1:240 MORRIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3278
Practice Address - Country:US
Practice Address - Phone:801-823-1486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103406103T00000X
SC1873103T00000X
TN4040103T00000X
UT13820914-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT13820914-2501OtherLICENSE
NC103406OtherLICENSE