Provider Demographics
NPI:1083263479
Name:JORDAN, CAROLYN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:TROADEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 SAN JUAN DR SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3453
Mailing Address - Country:US
Mailing Address - Phone:714-392-3040
Mailing Address - Fax:
Practice Address - Street 1:1032 SAN JUAN DR SE
Practice Address - Street 2:
Practice Address - City:EAST GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3453
Practice Address - Country:US
Practice Address - Phone:714-392-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist