Provider Demographics
NPI:1669154340
Name:JORDAN, DANIELE (EDD)
Entity type:Individual
Prefix:DR
First Name:DANIELE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 HICKORY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5452
Mailing Address - Country:US
Mailing Address - Phone:281-414-3457
Mailing Address - Fax:
Practice Address - Street 1:3611 HICKORY HILL LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5452
Practice Address - Country:US
Practice Address - Phone:281-414-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional