Provider Demographics
NPI:1154069326
Name:JORDAN, LABRETHA
Entity Type:Individual
Prefix:
First Name:LABRETHA
Middle Name:
Last Name:JORDAN
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 1:2823 RIVERBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4261
Mailing Address - Country:US
Mailing Address - Phone:214-543-3740
Mailing Address - Fax:469-436-3891
Practice Address - Street 1:2823 RIVERBROOK CIR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4261
Practice Address - Country:US
Practice Address - Phone:214-543-3740
Practice Address - Fax:469-436-3891
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty