Basic Information
| Provider Information | |||||||||
| NPI: | 1649556432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 GAYE LN | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760124613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179445360 | ||||||||
| FaxNumber: | 8175169102 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 WESTWAY PL | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760185245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179445360 | ||||||||
| FaxNumber: | 8175169102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2011 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 61220 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 288320901 | 05 | TX | MEDICAID |