Provider Demographics
NPI:1265920979
Name:VENABLE, JORDAN MARIE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:VENABLE
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 1:10503 METRIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:972-644-2076
Mailing Address - Fax:
Practice Address - Street 1:15911 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-599-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2023-01-10
Deactivation Date:2019-09-30
Deactivation Code:
Reactivation Date:2019-10-10
Provider Licenses
StateLicense IDTaxonomies
TX3016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst