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NPI Code Detail

MEDICARE: JORDAN WHITE

MEDICARE: JORDAN WHITE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1083576540
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WHITE
Provider Business Mailing Address
First Line : 3700 RIDGE COUNTRY ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-3463
Country : US
Telephone Number : 210-598-7212
Fax Number : 866-811-2590
Provider Business Practice Location Address
First Line : 3700 RIDGE COUNTRY ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-3463
Country : US
Telephone Number : 210-598-7212
Fax Number : 866-811-2590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2025
Last Update Date : 12/02/2025

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Directions to “ JORDAN WHITE ” Practice Location

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