Provider Demographics
NPI:1336486471
Name:JORDAN, BETH N (MED; LPCC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:N
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MED; LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4136
Mailing Address - Country:US
Mailing Address - Phone:270-804-9602
Mailing Address - Fax:
Practice Address - Street 1:2850 ADAMS ST
Practice Address - Street 2:SUITE 11
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4109
Practice Address - Country:US
Practice Address - Phone:270-804-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00223768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional