Provider Demographics
NPI:1073920310
Name:KORDICH, JAMIE IRENE (CPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:IRENE
Last Name:KORDICH
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W CHARLESTON BLVD STE 74
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1910
Mailing Address - Country:US
Mailing Address - Phone:725-291-2700
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 74
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1910
Practice Address - Country:US
Practice Address - Phone:725-291-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP2960101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCP2960OtherCLINICAL PROFESSIONAL COUNSELOR LICENSE