Provider Demographics
NPI:1750166450
Name:JORDAN, AMY B (LMSW MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:JORDAN
Suffix:
Gender:
Credentials:LMSW MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 COUNCIL BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-2618
Mailing Address - Country:US
Mailing Address - Phone:512-680-1867
Mailing Address - Fax:
Practice Address - Street 1:12343 HYMEADOW DR STE 3E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1858
Practice Address - Country:US
Practice Address - Phone:512-861-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104666104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker