Provider Demographics
NPI:1073201109
Name:CURTIS, JORDAN A (PCA, NCC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SE ALDER ST
Mailing Address - Street 2:SUITE 301, BOX 028
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-546-1679
Mailing Address - Fax:866-383-0024
Practice Address - Street 1:1110 SE ALDER ST STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:503-546-1679
Practice Address - Fax:866-383-0024
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional