Provider Demographics
NPI:1598928889
Name:JORDAN, JAMES B (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:B
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPCC
Mailing Address - Street 1:453 CERRILLOS RD., BLDG. E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-699-6440
Mailing Address - Fax:
Practice Address - Street 1:453 CERRILLOS RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3784
Practice Address - Country:US
Practice Address - Phone:505-699-6440
Practice Address - Fax:505-699-6440
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0108141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33552070Medicaid