Provider Demographics
NPI:1225620917
Name:JORDAN, BETHANY (PLMFT, PLPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PLMFT, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 GLENMAR AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4974
Mailing Address - Country:US
Mailing Address - Phone:318-654-7010
Mailing Address - Fax:
Practice Address - Street 1:1812 GLENMAR AVE STE C
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4974
Practice Address - Country:US
Practice Address - Phone:318-654-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional