Provider Demographics
NPI:1033674338
Name:GONZALES, JORDAN ELESE (PLPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELESE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 HIGHLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2837
Mailing Address - Country:US
Mailing Address - Phone:225-323-6447
Mailing Address - Fax:
Practice Address - Street 1:8738 QUARTERS LAKE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2194
Practice Address - Country:US
Practice Address - Phone:225-276-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6980101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor