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571 S Edmonds Ln Ste 102 Lewisville TX 75067-3645 | |
| (972) 436-3118 | |
| (972) 353-4259 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 571 S Edmonds Ln Ste 102, Lewisville, Texas |
| Authorized Official Name and Position | Kevin D Jones (OWNER) |
| Authorized Official Contact | 9724363118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
571 S Edmonds Ln Ste 102 Lewisville TX 75067-3645 Ph: (972) 436-3118 | 571 S Edmonds Ln Ste 102 Lewisville TX 75067-3645 Ph: (972) 436-3118 |
| NPI Number | 1316218654 |
|---|---|
| Provider Enumeration Date | 01/18/2012 |
| Last Update Date | 01/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316218654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 14281 (Texas) | Primary |
| 106H00000X | Marriage & Family Therapist | 4894 (Texas) | Secondary |
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