Provider Demographics
NPI:1578237277
Name:STANFORD, JORDON AVERY (LMFT-A)
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:AVERY
Last Name:STANFORD
Suffix:
Gender:M
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 CAPRIOLA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3715
Mailing Address - Country:US
Mailing Address - Phone:435-669-0568
Mailing Address - Fax:
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 19A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3329
Practice Address - Country:US
Practice Address - Phone:737-216-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203993106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist