Active NPI
Jordan Marie Venable
- Behavior Analyst
- San Antonio, TX
National Provider Identifier
1265920979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 3016
- Practice address
- 15911 Nacogdoches Rd
San Antonio, TX 78247 - Phone
- (210) 599-7733
- NPI assigned
- Apr 27, 2018
- Reactivated
- Oct 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 3016 | TX | Primary |
Addresses
Primary practice location
15911 Nacogdoches Rd
San Antonio, TX 78247
Mailing address
10503 Metric Drive
Dallas, TX 75243
Phone (972) 644-2076
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3016 | TX | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bloom Behavioral & Educational Solutions, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- San Antonio, TX
- NPI 1962829382
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673308800000",
"number": "1265920979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10503 METRIC DRIVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "75243",
"telephone_number": "972-644-2076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15911 NACOGDOCHES RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78247",
"telephone_number": "210-599-7733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENABLE",
"first_name": "JORDAN",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-27",
"last_updated": "2023-01-10",
"certification_date": "2023-01-10",
"deactivation_date": "2019-09-30",
"reactivation_date": "2019-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "3016",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.