Provider Demographics
NPI:1073660544
Name:JORDAN, DEBBIE (LCPC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCPC
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 44582
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0582
Mailing Address - Country:US
Mailing Address - Phone:208-342-2273
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:1910 N LAKES PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-342-2273
Practice Address - Fax:208-323-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010032560OtherREGENCE BLUE SHIELD OF ID
IDQ4897OtherBLUE CROSS OF ID