Provider Demographics
NPI:1083124440
Name:PRIETO, JORDAN SANTOS CONRADO (LPC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:SANTOS CONRADO
Last Name:PRIETO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 QUAKER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 QUAKER AVE STE D
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5138
Practice Address - Country:US
Practice Address - Phone:806-687-5413
Practice Address - Fax:806-317-1588
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional