Provider Demographics
NPI:1114241767
Name:JORDAN, LAURA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 NICHOLS RD APT 1215
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-8638
Mailing Address - Country:US
Mailing Address - Phone:936-334-2507
Mailing Address - Fax:
Practice Address - Street 1:4900 NICHOLS RD APT 1215
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8638
Practice Address - Country:US
Practice Address - Phone:936-334-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst