=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275723256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOIS M. JORDAN DBA SOLUTIONS OUTPATIENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5327 N. CENTRAL EXPRESSWAY SUITE 333
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-1155
-----------------------------------------------------
Fax | 214-369-1710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5327 N. CENTRAL EXPRESSWAY SUITE 333
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-1155
-----------------------------------------------------
Fax | 214-369-1710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LOIS M. JORDAN
-----------------------------------------------------
Credential | LCSW, LCDC
-----------------------------------------------------
Telephone | 214-369-1155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 882-A
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------