Provider Demographics
NPI:1194295634
Name:JORDAN, RENEE S (MASTERS IN EDUCATION)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:S
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 MATTIE REEVES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5719
Mailing Address - Country:US
Mailing Address - Phone:337-540-7098
Mailing Address - Fax:
Practice Address - Street 1:2110 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7864
Practice Address - Country:US
Practice Address - Phone:337-475-0324
Practice Address - Fax:337-475-8917
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical