Provider Demographics
NPI:1598809576
Name:JORDAN, STEPHANIE (OMD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OMD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 W SAHARA AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2763
Mailing Address - Country:US
Mailing Address - Phone:702-382-8484
Mailing Address - Fax:702-382-3755
Practice Address - Street 1:7390 W SAHARA AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2763
Practice Address - Country:US
Practice Address - Phone:702-382-8484
Practice Address - Fax:702-382-3755
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3356103T00000X
NV1014171100000X
FL1164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist