Provider Demographics
NPI:1154728566
Name:MANDY JORDAN PH.D.
Entity type:Organization
Organization Name:MANDY JORDAN PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-916-8200
Mailing Address - Street 1:3509 HULEN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6800
Mailing Address - Country:US
Mailing Address - Phone:817-916-8200
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6800
Practice Address - Country:US
Practice Address - Phone:817-916-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34438251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health