MEDICARE: JANIS ANDERSON JORDAN MS, LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8867	TX
2	106H00000X	Marriage & Family Therapist	183	TX

General Provider Information

NPI Number	:	1538294525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS ANDERSON JORDAN MS, LPC, LMFT

Provider Business Mailing Address
First Line	:	3501 LOVAGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-3006
Country	:	US
Telephone Number	:	512-255-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N MO PAC EXPY
Second Line	:	SUITE 814
City	:	AUSTIN
State	:	TX
Zip	:	78759-8375
Country	:	US
Telephone Number	:	512-795-7709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/30/2007

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