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General NPI Number Information
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NPI Number | 1609323310
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Entity Type | Individual
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Provider Name | JORDAN ELLIOTT LPC, LCDC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2016
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR STE 7402
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 208-874-7036
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Fax |
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Provider Business Mailing Address
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Address Line | 5837 DE ZAVALA RD. P. O. BOX 690102
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City | SAN ANTONIO
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State | TX
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Zip | 78249
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Country | US
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Telephone | 361-861-5155
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Fax |
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 80261
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License Number State | TX
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