Provider Demographics
NPI:1588036024
Name:JORDAN, JEFFERSON JR
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:JORDAN
Suffix:JR
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 1:8325 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4804
Mailing Address - Country:US
Mailing Address - Phone:225-239-5498
Mailing Address - Fax:
Practice Address - Street 1:8325 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4804
Practice Address - Country:US
Practice Address - Phone:225-239-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health