Provider Demographics
NPI:1326185117
Name:ROBINSON, JORDAN JAMES
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:JAMES
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 NW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5526
Mailing Address - Country:US
Mailing Address - Phone:503-472-4020
Mailing Address - Fax:503-472-8630
Practice Address - Street 1:819 N HWY 99W SUITE B
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4123
Practice Address - Country:US
Practice Address - Phone:503-434-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101Y00000X101YM0800X
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health