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NPI Code Detail

MEDICARE: MELISSA ILIONE JORDAN LMFT

MEDICARE:   MELISSA ILIONE JORDAN  LMFT
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
1106H00000XMarriage & Family Therapist201410TX

General Provider Information

NPI Number : 1356547848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ILIONE JORDAN LMFT
Provider Business Mailing Address
First Line : 4419 EL SIMPATICO ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78233-6800
Country : US
Telephone Number : 210-268-3702
Fax Number :
Provider Business Practice Location Address
First Line : 620 E AFTON OAKS BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1236
Country : US
Telephone Number : 210-568-8554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2007
Last Update Date : 09/03/2010

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Directions to “ MELISSA ILIONE JORDAN LMFT” Practice Location

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