Provider Demographics
NPI:1780193755
Name:LIDSTROM, JORDAN LEANN (LPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEANN
Last Name:LIDSTROM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 KING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1326
Mailing Address - Country:US
Mailing Address - Phone:763-742-2998
Mailing Address - Fax:
Practice Address - Street 1:325 KING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-1326
Practice Address - Country:US
Practice Address - Phone:763-742-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018702101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health