Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 62897 | TX |
NPI | 1003119728 |
---|---|
Provider Name | Marjorie Jordan |
First Address | Spring, TX 77380-1916 |
Second Address | Spring, TX 77380-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2010 |
Last Update Date | 20/08/2019 |