Provider Demographics
NPI:1760285639
Name:BANUELOS, JORDAN JANAE (LPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JANAE
Last Name:BANUELOS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:JANAE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7031 TOLUCA DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3762
Mailing Address - Country:US
Mailing Address - Phone:770-733-0800
Mailing Address - Fax:
Practice Address - Street 1:7031 TOLUCA DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3762
Practice Address - Country:US
Practice Address - Phone:770-733-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health