Provider Demographics
NPI:1609386242
Name:KULAGA, JORDAN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:KULAGA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31512 WALNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-4014
Mailing Address - Country:US
Mailing Address - Phone:432-230-2304
Mailing Address - Fax:
Practice Address - Street 1:31512 WALNUT CREEK RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-4014
Practice Address - Country:US
Practice Address - Phone:432-230-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst