Provider Demographics
NPI:1689166365
Name:EDWARDS, JORDAN (LADC-US)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LADC-US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1505
Mailing Address - Country:US
Mailing Address - Phone:405-840-9000
Mailing Address - Fax:
Practice Address - Street 1:2113 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-1505
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor