Provider Demographics
NPI:1417219932
Name:JORDAN, LAURA JANE (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RUSTIC COLONY LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4899
Mailing Address - Country:US
Mailing Address - Phone:281-317-7237
Mailing Address - Fax:
Practice Address - Street 1:1100 NASA PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3325
Practice Address - Country:US
Practice Address - Phone:281-317-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health