Provider Demographics
NPI:1134018427
Name:RAINES, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GARDEN OF THE GODS RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3432
Mailing Address - Country:US
Mailing Address - Phone:719-354-5297
Mailing Address - Fax:719-960-2712
Practice Address - Street 1:1015 GARDEN OF THE GODS RD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3432
Practice Address - Country:US
Practice Address - Phone:719-354-5297
Practice Address - Fax:719-960-2712
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician