Individual
MANDY J JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
12416 BEARTRAP LN, AUSTIN, TX 78729-7938
(817) 916-8200
(817) 717-6571
Mailing address
PO BOX 202636, AUSTIN, TX 78720-2636
(817) 916-8200
(817) 717-6571
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
34438
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212411701
—
TX
Enumeration date
03/24/2010
Last updated
07/16/2021
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