Provider Demographics
NPI:1033563564
Name:MORIN, JORDAN MCDONALD
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MCDONALD
Last Name:MORIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 FLYNN PKWY STE 506
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4392
Mailing Address - Country:US
Mailing Address - Phone:361-688-2896
Mailing Address - Fax:
Practice Address - Street 1:1630 S BROWNLEE BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3134
Practice Address - Country:US
Practice Address - Phone:361-980-9652
Practice Address - Fax:361-993-8509
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX72779OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS