Provider Demographics
NPI:1427582683
Name:WILLIAMS, JORDAN TAYLOR
Entity Type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:TAYLOR
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-5940
Mailing Address - Country:US
Mailing Address - Phone:918-284-5822
Mailing Address - Fax:
Practice Address - Street 1:1217 E 33RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2017
Practice Address - Country:US
Practice Address - Phone:918-779-4556
Practice Address - Fax:918-895-6917
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health