Provider Demographics
NPI:1922340785
Name:JAMES R JORDAN MS, NCC, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:JAMES R JORDAN MS, NCC, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LMHC
Authorized Official - Phone:631-786-0842
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-0063
Mailing Address - Country:US
Mailing Address - Phone:631-786-0842
Mailing Address - Fax:
Practice Address - Street 1:595 ROUTE 25A
Practice Address - Street 2:SUITE #15
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2646
Practice Address - Country:US
Practice Address - Phone:631-786-0842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty