Provider Demographics
NPI:1841768348
Name:JORDAN, SHERONE NICOLE
Entity Type:Individual
Prefix:
First Name:SHERONE
Middle Name:NICOLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29910 VALLEY TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1630
Mailing Address - Country:US
Mailing Address - Phone:254-338-9580
Mailing Address - Fax:
Practice Address - Street 1:11777 KATY FWY STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1784
Practice Address - Country:US
Practice Address - Phone:713-365-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77887OtherLICENSED PROFESSIONAL COUNSELOR INTERN