Provider Demographics
NPI:1477904126
Name:SOPER, JORDAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SOPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 PASEO VERDE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7136
Mailing Address - Country:US
Mailing Address - Phone:702-508-9181
Mailing Address - Fax:
Practice Address - Street 1:2460 PASEO VERDE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7136
Practice Address - Country:US
Practice Address - Phone:702-508-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60632945103T00000X
NVPY0808103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist