Provider Demographics
NPI:1427039692
Name:JORDAN HART, PH.D., L.P., LLC
Entity Type:Organization
Organization Name:JORDAN HART, PH.D., L.P., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-414-3540
Mailing Address - Street 1:615 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4602
Mailing Address - Country:US
Mailing Address - Phone:612-414-3540
Mailing Address - Fax:612-823-8438
Practice Address - Street 1:615 W 35TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4602
Practice Address - Country:US
Practice Address - Phone:612-414-3540
Practice Address - Fax:612-823-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4313261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN991N8HAOtherBCBS CLINIC PIN
MN108187OtherHEALTHPARTNERS HPFIN
MN61-33379OtherUBH/MEDICA