Provider Demographics
NPI:1912918293
Name:JORDAN, JASON TERRY (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:TERRY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 LEE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4247
Mailing Address - Country:US
Mailing Address - Phone:903-454-6334
Mailing Address - Fax:903-454-1153
Practice Address - Street 1:2611 LEE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4247
Practice Address - Country:US
Practice Address - Phone:903-454-6334
Practice Address - Fax:903-454-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128064OtherVALUE OPTIONS
TX6565LCOtherBLUE CROSS BLUE SHIELD