Provider Demographics
NPI:1821832866
Name:SPENCE, JORDAN LEIGH STANLEY (BCBA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH STANLEY
Last Name:SPENCE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1502 SUMMER RAIN DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3069
Mailing Address - Country:US
Mailing Address - Phone:832-407-0785
Mailing Address - Fax:
Practice Address - Street 1:1502 SUMMER RAIN DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3069
Practice Address - Country:US
Practice Address - Phone:832-407-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-23-66124103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty