Individual
DR. JORDAN MICHAEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
(240) 857-7186
Mailing address
1100 WILFORD HALL LOOP, BLDG. 4554, 59 MDW/GME, JBSA LACKLAND, JBSA LACKLAND, TX 78236
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810007310
VA
103TH0004X
Health Psychologist
—
—
Other
Enumeration date
04/24/2019
Last updated
06/16/2025
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