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General NPI Number Information
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NPI Number | 1508682360
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Entity Type | Individual
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Provider Name | JORDAN ELIZABETH LEWIS LMFT-A
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1701 W NORTHWEST HWY STE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051-8145
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Country | US
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Telephone | 817-221-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 N MAIN ST APT 1235
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City | KELLER
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State | TX
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Zip | 76248-3950
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Country | US
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Telephone | 817-372-0523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 205553
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License Number State | TX
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