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General NPI Number Information
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NPI Number | 1265632376
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Entity Type | Individual
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Provider Name | JORGE C CORDOVA LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 2916 W T C JESTER BLVD STE 102
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City | HOUSTON
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State | TX
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Zip | 77018-7051
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Country | US
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Telephone | 713-263-0829
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Fax | 713-263-9539
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Provider Business Mailing Address
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Address Line | 12623 IMPERIAL CROSSING DR
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City | TOMBALL
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State | TX
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Zip | 77377-4029
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Country | US
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Telephone | 281-290-9399
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Fax | 713-263-9539
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 02131
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 02131
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License Number State | TX
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