Provider Demographics
NPI:1558063917
Name:REWIS, JORDAN (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:REWIS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 TUCSON DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5257
Mailing Address - Country:US
Mailing Address - Phone:904-534-3193
Mailing Address - Fax:
Practice Address - Street 1:2903 TUCSON DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5257
Practice Address - Country:US
Practice Address - Phone:904-534-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional