Provider Demographics
NPI:1609323310
Name:ELLIOTT, JORDAN (LPC, LCDC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5837 DE ZAVALA RD.
Mailing Address - Street 2:P. O. BOX 690102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:361-861-5155
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 7402
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:208-874-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
TX80261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist