Provider Demographics
NPI:1114402609
Name:MILLINER, JORDAN ROSS
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROSS
Last Name:MILLINER
Suffix:
Gender:M
Credentials:
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 150
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-0150
Mailing Address - Country:US
Mailing Address - Phone:318-346-9288
Mailing Address - Fax:
Practice Address - Street 1:300 RUE BEAUREGARD STE F
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8511
Practice Address - Country:US
Practice Address - Phone:337-270-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst