Provider Demographics
NPI:1891566147
Name:COMBS, JORDAN ESTELLE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ESTELLE
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTEE
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6300 STONEWOOD DR STE 106B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5285
Mailing Address - Country:US
Mailing Address - Phone:405-633-2787
Mailing Address - Fax:
Practice Address - Street 1:701 E 15TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0708
Practice Address - Country:US
Practice Address - Phone:405-633-2787
Practice Address - Fax:972-739-3535
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health