=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942242052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA KAYE JONES LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 05/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 SOUTHRIDGE CT STE 105
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76053-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-614-1488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 GREGORY AVE
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76022-7842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-614-1488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | TX62205
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------