Individual provider Active NPI

Andrew Sean Jones, MA, PH.D

  • Psychologist
  • Salt Lake City, UT
National Provider Identifier
1922673136
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
13820914-2501 Issued in UT
Practice address
240 Morris Ave Ste 100
Salt Lake City, UT 84115-3278
Phone
(801) 823-1486
NPI assigned
May 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 103406 NC
Psychologist 103T00000X 1873 SC
Psychologist 103T00000X 4040 TN
Psychologist 103T00000X 13820914-2501 UT Primary

Addresses

Primary practice location

240 Morris Ave Ste 100
Salt Lake City, UT 84115-3278

Mailing address

16255 Ventura Blvd Ste 900
Encino, CA 91436-2317
Phone (801) 935-4171

Other practice location 1

138 Barium Springs Dr
Statesville, NC 28677-8453
Phone (704) 832-2200

Other identifiers 2

IdentifierTypeStateIssuer
13820914-2501OtherUTLICENSE
103406OtherNCLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
103406NCMDPsychologist
13820914-2501UTMDPsychologist
4040TNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Psychological Institute, PLLC Psychologist Current Accepting new patients
Barium Springs Home for Children PastSince May 1, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1922673136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16255 VENTURA BLVD STE 900",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362317",
            "telephone_number": "801-935-4171",
            "fax_number": "704-838-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MORRIS AVE STE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153278",
            "telephone_number": "801-823-1486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "138 Barium Springs Dr",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286778453",
            "country_code": "US",
            "telephone_number": "704-832-2200",
            "fax_number": "704-838-1541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONES",
        "first_name": "ANDREW",
        "middle_name": "SEAN",
        "credential": "MA, PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "103406",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SC",
            "license": "1873",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "4040",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "13820914-2501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "13820914-2501",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "103406",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.