Provider Demographics
NPI:1073913455
Name:JORDAN, CHRISTOPHER JUAN (LPCC-S)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JUAN
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 EWING ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2968
Mailing Address - Country:US
Mailing Address - Phone:419-269-7740
Mailing Address - Fax:
Practice Address - Street 1:2575 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-5201
Practice Address - Country:US
Practice Address - Phone:567-280-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300292101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health