Provider Demographics
NPI:1013642651
Name:GARZA, JORDAN CHANCE MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHANCE MARIE
Last Name:GARZA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 S FORT HOOD ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-2584
Mailing Address - Country:US
Mailing Address - Phone:207-814-8542
Mailing Address - Fax:207-261-1124
Practice Address - Street 1:1033 S FORT HOOD ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-2584
Practice Address - Country:US
Practice Address - Phone:207-814-8542
Practice Address - Fax:207-261-1124
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty