Provider Demographics
NPI:1881832897
Name:HAMBRICK, JORDAN SHAWN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:SHAWN
Last Name:HAMBRICK
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 1:950 MEADOW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1055
Mailing Address - Country:US
Mailing Address - Phone:419-947-4560
Mailing Address - Fax:419-947-2956
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1055
Practice Address - Country:US
Practice Address - Phone:419-947-4560
Practice Address - Fax:419-947-2956
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0700441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional