Provider Demographics
NPI:1770199911
Name:JORGES, MARK (LPC-INTERN, LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JORGES
Suffix:
Gender:M
Credentials:LPC-INTERN, LCDC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:JORGES, LPC-INTERN, LCDC, NCC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-INTERN, LCDC
Mailing Address - Street 1:6701 OLIVER LOVING DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6928
Mailing Address - Country:US
Mailing Address - Phone:254-258-8595
Mailing Address - Fax:
Practice Address - Street 1:6701 OLIVER LOVING DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6928
Practice Address - Country:US
Practice Address - Phone:254-258-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83107101Y00000X
TX14977101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty