Provider Demographics
NPI:1265632376
Name:CORDOVA, JORGE C (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:C
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12623 IMPERIAL CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-4029
Mailing Address - Country:US
Mailing Address - Phone:281-290-9399
Mailing Address - Fax:713-263-9539
Practice Address - Street 1:2916 W T C JESTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-7051
Practice Address - Country:US
Practice Address - Phone:713-263-0829
Practice Address - Fax:713-263-9539
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02131101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health