Healthcare Provider Details

I. General information

NPI: 1053225623
Provider Name (Legal Business Name): DIRESHAN J JORDAN RBT,CPR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 READING RD STE 190
ROSENBERG TX
77471-6889
US

IV. Provider business mailing address

5149 READING RD STE 190
ROSENBERG TX
77471-6889
US

V. Phone/Fax

Practice location:
  • Phone: 281-725-6389
  • Fax:
Mailing address:
  • Phone: 281-725-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25471536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: