Provider Demographics
NPI:1437817855
Name:JORDAN, KEVIN DANTE
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DANTE
Last Name:JORDAN
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 1:114 E SHAW AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7621
Mailing Address - Country:US
Mailing Address - Phone:559-243-7002
Mailing Address - Fax:
Practice Address - Street 1:3138 W BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2603
Practice Address - Country:US
Practice Address - Phone:559-439-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor