Provider Demographics
NPI:1023889888
Name:JOHNSON, JORDAN SCOTT (LPCC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PROSPEROUS PL STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1898
Mailing Address - Country:US
Mailing Address - Phone:859-214-7440
Mailing Address - Fax:
Practice Address - Street 1:161 PROSPEROUS PL STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1898
Practice Address - Country:US
Practice Address - Phone:859-214-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional