Provider Demographics
NPI:1104523869
Name:JORDAN, LARK CHERI (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:LARK
Middle Name:CHERI
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:LARK
Other - Middle Name:CHERI
Other - Last Name:POKLADNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:8650 SOUTHWESTERN BLVD APT 2805
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2685
Mailing Address - Country:US
Mailing Address - Phone:214-608-0259
Mailing Address - Fax:
Practice Address - Street 1:4144 N CENTRAL EXPY STE 850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3226
Practice Address - Country:US
Practice Address - Phone:972-865-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health