Provider Demographics
NPI:1053669481
Name:JORDAN, COLLEEN REBECCA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:REBECCA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S CHURCH ST
Mailing Address - Street 2:6TH FLOOR SUITE 6
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6157
Mailing Address - Country:US
Mailing Address - Phone:413-358-4757
Mailing Address - Fax:
Practice Address - Street 1:75 S CHURCH ST
Practice Address - Street 2:6TH FLOOR SUITE 6
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6157
Practice Address - Country:US
Practice Address - Phone:413-358-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health