Provider Demographics
NPI:1235868183
Name:BRUBAKER, JORDAN (MA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:INIGARIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14275 MIDWAY RD STE 260
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3613
Practice Address - Country:US
Practice Address - Phone:405-534-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist