Provider Demographics
NPI:1366018095
Name:WILLIAMS, JORDAN (RBT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ROBERTS CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2825
Mailing Address - Country:US
Mailing Address - Phone:800-875-1911
Mailing Address - Fax:
Practice Address - Street 1:905 ROBERTS CUT OFF RD
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2825
Practice Address - Country:US
Practice Address - Phone:800-875-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician