Provider Demographics
NPI:1134469448
Name:JORDAN, MICHAEL JACK (DBSA FACILITATOR)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JACK
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DBSA FACILITATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LINDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4423
Mailing Address - Country:US
Mailing Address - Phone:405-314-7315
Mailing Address - Fax:
Practice Address - Street 1:1418 LINDALE AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4423
Practice Address - Country:US
Practice Address - Phone:405-314-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health