Healthcare Provider Details

I. General information

NPI: 1558139782
Provider Name (Legal Business Name): JORDAN A. HOUSTON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN A. NORTHROP MS

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 DUGAR BROOK RD
EAST CALAIS VT
05650-8051
US

IV. Provider business mailing address

1903 DUGAR BROOK RD
EAST CALAIS VT
05650-8051
US

V. Phone/Fax

Practice location:
  • Phone: 802-498-4883
  • Fax:
Mailing address:
  • Phone: 802-498-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0108701
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: