Provider Demographics
NPI:1104341940
Name:JOURDAIN, ANGELA MARIE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:JOURDAIN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 FLORENCE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7903
Mailing Address - Country:US
Mailing Address - Phone:254-371-4661
Mailing Address - Fax:254-774-9315
Practice Address - Street 1:1519 FLORENCE RD STE 16
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7903
Practice Address - Country:US
Practice Address - Phone:254-371-4661
Practice Address - Fax:254-774-9315
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health