Provider Demographics
NPI:1619300860
Name:JORDAN, TAMRA S (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:S
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8124
Mailing Address - Country:US
Mailing Address - Phone:281-928-4669
Mailing Address - Fax:
Practice Address - Street 1:1235 CLEAR LAKE CITY BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8124
Practice Address - Country:US
Practice Address - Phone:281-928-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist