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NPI Code Detail

MEDICARE: SHELITA SHUNTA JORDAN LPC ASOTP

MEDICARE:   SHELITA SHUNTA JORDAN  LPC ASOTP
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
1101YP2500XProfessional Counselor78322TX

General Provider Information

NPI Number : 1447871371
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELITA SHUNTA JORDAN LPC ASOTP
Provider Business Mailing Address
First Line : 101 FEU FOLLET RD STE 100
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-4234
Country : US
Telephone Number : 832-282-3351
Fax Number :
Provider Business Practice Location Address
First Line : 1431 STONE MESA DR
Second Line :
City : HOUSTON
State : TX
Zip : 77073-2755
Country : US
Telephone Number : 832-282-3351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2020
Last Update Date : 10/03/2023

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Directions to “ SHELITA SHUNTA JORDAN LPC ASOTP” Practice Location

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