Provider Demographics
NPI:1669364774
Name:RICO, JORDAN ANTHONY (LCSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANTHONY
Last Name:RICO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 RESEARCH BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6299
Mailing Address - Country:US
Mailing Address - Phone:515-505-0212
Mailing Address - Fax:
Practice Address - Street 1:8140 N MOPAC EXPY STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8837
Practice Address - Country:US
Practice Address - Phone:512-812-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1105461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical