Provider Demographics
NPI:1003524778
Name:JORDAN, BOBBI (PLPC)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11021 ROYAL ASCOT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4056
Mailing Address - Country:US
Mailing Address - Phone:225-776-7156
Mailing Address - Fax:
Practice Address - Street 1:3015 HIGHWAY 956
Practice Address - Street 2:
Practice Address - City:ETHEL
Practice Address - State:LA
Practice Address - Zip Code:70730-4520
Practice Address - Country:US
Practice Address - Phone:225-924-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health