Provider Demographics
NPI:1558753889
Name:CHILD, JORDAN LYNDSEY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:LYNDSEY
Last Name:CHILD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321B GREENVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3231
Mailing Address - Country:US
Mailing Address - Phone:706-887-5787
Mailing Address - Fax:706-780-5402
Practice Address - Street 1:321B GREENVILLE STREET
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3231
Practice Address - Country:US
Practice Address - Phone:706-887-5787
Practice Address - Fax:706-780-5402
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001596106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003202428IMedicaid