Provider Demographics
NPI:1689279846
Name:JORDAN WHITE, LCSW
Entity Type:Organization
Organization Name:JORDAN WHITE, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-808-9462
Mailing Address - Street 1:110 S MCGREGOR CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-5201
Mailing Address - Country:US
Mailing Address - Phone:303-808-9462
Mailing Address - Fax:
Practice Address - Street 1:605 S KUNER RD STE 207
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2864
Practice Address - Country:US
Practice Address - Phone:303-808-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health