Provider Demographics
NPI:1124729744
Name:MAY, JORDAN LEIGH (MA)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:LEIGH
Last Name:MAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MAY
Other - Last Name:FAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2911 POST OAK CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3432
Mailing Address - Country:US
Mailing Address - Phone:817-832-4319
Mailing Address - Fax:
Practice Address - Street 1:3435 ACTON HWY
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7505
Practice Address - Country:US
Practice Address - Phone:817-578-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19-565221700000X
TX83642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist