Provider Demographics
NPI:1275615437
Name:JORDAN, MARY JAN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JAN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4563
Mailing Address - Country:US
Mailing Address - Phone:913-433-2061
Mailing Address - Fax:913-262-0818
Practice Address - Street 1:536 FIRESIDE COURT
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2300
Practice Address - Country:US
Practice Address - Phone:785-841-0307
Practice Address - Fax:785-832-1710
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS139101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor