Provider Demographics
NPI:1427600576
Name:JORDAN PHILBERT, LEVINA (MFT-I)
Entity Type:Individual
Prefix:
First Name:LEVINA
Middle Name:
Last Name:JORDAN PHILBERT
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BOULDER FALLS ST APT 1062
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4956
Mailing Address - Country:US
Mailing Address - Phone:571-719-9291
Mailing Address - Fax:
Practice Address - Street 1:5880 BOULDER FALLS ST APT 1062
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4956
Practice Address - Country:US
Practice Address - Phone:571-719-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV1262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program