Provider Demographics
NPI:1124568837
Name:JORDAN, SHANNON REA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:REA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2645
Mailing Address - Country:US
Mailing Address - Phone:810-660-8686
Mailing Address - Fax:810-788-1043
Practice Address - Street 1:550 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2645
Practice Address - Country:US
Practice Address - Phone:810-255-0888
Practice Address - Fax:810-788-1043
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional