MEDICARE: LAURA JANE JORDAN LPC, 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
1	101YM0800X	Mental Health Counselor	66853	TX

General Provider Information

NPI Number	:	1417219932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JANE JORDAN LPC, LMFT

Provider Business Mailing Address
First Line	:	125 RUSTIC COLONY LN
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4899
Country	:	US
Telephone Number	:	281-317-7237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NASA PKWY
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77058-3325
Country	:	US
Telephone Number	:	281-317-7237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	12/12/2013

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