Provider Demographics
NPI:1891419131
Name:GIVENS, JORDAN NICOLE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:GIVENS
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 1:115 KOHLERS XING
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2460
Mailing Address - Country:US
Mailing Address - Phone:737-843-2058
Mailing Address - Fax:
Practice Address - Street 1:115 KOHLERS XING
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2460
Practice Address - Country:US
Practice Address - Phone:737-843-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician