Provider Demographics
NPI:1922567346
Name:JORDAN, REGINALD (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 RANGER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5630
Mailing Address - Country:US
Mailing Address - Phone:469-337-0321
Mailing Address - Fax:
Practice Address - Street 1:2360 RANGER DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-5630
Practice Address - Country:US
Practice Address - Phone:469-337-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical