Provider Demographics
NPI:1861786170
Name:JORDON, KALE TIMOTHY (LPC)
Entity type:Individual
Prefix:
First Name:KALE
Middle Name:TIMOTHY
Last Name:JORDON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N COMAL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4214
Mailing Address - Country:US
Mailing Address - Phone:210-404-9399
Mailing Address - Fax:210-481-7175
Practice Address - Street 1:1731 N COMAL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4214
Practice Address - Country:US
Practice Address - Phone:210-404-9399
Practice Address - Fax:210-481-7175
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional