Individual
CILLY JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-S, LSOTP
Contact information
Practice address
135 BUNTON CREEK RD, SUITE 304, KYLE, TX 78640-5787
(512) 217-6072
(512) 268-2759
Mailing address
135 BUNTON CREEK RD, SUITE 304, KYLE, TX 78640-5787
(512) 217-6072
(512) 268-2759
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LSOTP 98981
TX
101YP2500X
Professional Counselor
Primary
19069
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1737843-01
—
TX
01
—
7447LC
BCBS TPI
TX
Enumeration date
03/23/2007
Last updated
07/31/2015
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