Provider Demographics
NPI:1275280042
Name:CELEJ, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CELEJ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10221 FORD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-0259
Mailing Address - Country:US
Mailing Address - Phone:912-445-6063
Mailing Address - Fax:912-445-6064
Practice Address - Street 1:10221 FORD AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-0259
Practice Address - Country:US
Practice Address - Phone:912-445-6063
Practice Address - Fax:912-445-6064
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14268106E00000X
GARBT-22-204268106S00000X
GA1-25-80513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician