Provider Demographics
NPI:1912889478
Name:CORIZ, JORDANA KELSEY (CCSS)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:KELSEY
Last Name:CORIZ
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87057
Mailing Address - Country:US
Mailing Address - Phone:505-239-1718
Mailing Address - Fax:
Practice Address - Street 1:18 EAGLE CT
Practice Address - Street 2:PO BOX 90
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87057
Practice Address - Country:US
Practice Address - Phone:505-239-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician