Provider Demographics
NPI:1619203379
Name:TIMI JORDISON PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:TIMI JORDISON PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMI
Authorized Official - Middle Name:DEE FRIEDERICHS
Authorized Official - Last Name:JORDISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-573-3628
Mailing Address - Street 1:1728 CENTRAL AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-573-3628
Mailing Address - Fax:515-573-3628
Practice Address - Street 1:1728 CENTRAL AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-573-3628
Practice Address - Fax:515-573-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001080103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty