Provider Demographics
NPI:1235335241
Name:JORDAN, MELISSA DAWN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DAWN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 BUCKHORN LN
Mailing Address - Street 2:
Mailing Address - City:BUCKHORN
Mailing Address - State:KY
Mailing Address - Zip Code:41721-8987
Mailing Address - Country:US
Mailing Address - Phone:606-398-7000
Mailing Address - Fax:606-398-7912
Practice Address - Street 1:116 BUCKHORN LN
Practice Address - Street 2:
Practice Address - City:BUCKHORN
Practice Address - State:KY
Practice Address - Zip Code:41721-8987
Practice Address - Country:US
Practice Address - Phone:606-398-7000
Practice Address - Fax:606-398-7912
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health