Provider Demographics
NPI:1770180432
Name:GERREN, JORDAN (RBT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GERREN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 BOWSMAN DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-7970
Mailing Address - Country:US
Mailing Address - Phone:713-550-6961
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR STE 220
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4895
Practice Address - Country:US
Practice Address - Phone:936-828-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-96661106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician