Provider Demographics
NPI:1649545021
Name:JORDAN, CATHY K (MED,LPC)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:K
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6128
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-6128
Mailing Address - Country:US
Mailing Address - Phone:281-768-1619
Mailing Address - Fax:281-360-4617
Practice Address - Street 1:3845 CYPRESS CREEK PKWY STE 217
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3531
Practice Address - Country:US
Practice Address - Phone:281-768-1619
Practice Address - Fax:281-360-4617
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-18
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66875101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2950628Medicaid