Provider Demographics
NPI:1093829814
Name:JORDAN, JANETTE LYNN (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:LYNN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8636 BARROW GLEN LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3617
Mailing Address - Country:US
Mailing Address - Phone:512-280-7337
Mailing Address - Fax:512-280-7327
Practice Address - Street 1:8636 BARROW GLEN LOOP
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3617
Practice Address - Country:US
Practice Address - Phone:512-280-7337
Practice Address - Fax:512-280-7327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168931041C0700X
TX3359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW00S89X4Medicaid
TX00S89XMedicare ID - Type Unspecified