Provider Demographics
NPI:1427136910
Name:JONES, KEVIN DALE (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DALE
Last Name:JONES
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S EDMONDS LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3510
Mailing Address - Country:US
Mailing Address - Phone:972-436-3118
Mailing Address - Fax:972-353-4259
Practice Address - Street 1:571 S EDMONDS LN
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3510
Practice Address - Country:US
Practice Address - Phone:972-436-3118
Practice Address - Fax:972-353-4259
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14281101YP2500X
TX4894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743025105OtherEMPLOYER IDENTIFICATION N
TX27-4066178OtherEMPLOYER IDENTIFICATION NUMBER