Provider Demographics
NPI:1467004879
Name:TASKER, JORDAN RILEY (LLPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RILEY
Last Name:TASKER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RILEY
Other - Last Name:SARGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:2247 HEMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3407
Mailing Address - Country:US
Mailing Address - Phone:810-618-4374
Mailing Address - Fax:
Practice Address - Street 1:42815 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1143
Practice Address - Country:US
Practice Address - Phone:586-333-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017493101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty