Provider Demographics
NPI:1891355566
Name:CLAPP, JORDAN A
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:A
Last Name:CLAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16134 AMBUSH GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1867
Mailing Address - Country:US
Mailing Address - Phone:626-201-1634
Mailing Address - Fax:
Practice Address - Street 1:16134 AMBUSH GRV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1867
Practice Address - Country:US
Practice Address - Phone:626-201-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB506659106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician