Provider Demographics
NPI:1245363225
Name:PREBYS, JORDAN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:PREBYS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 E CASSTOWN CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CASSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45312-9746
Mailing Address - Country:US
Mailing Address - Phone:937-717-8643
Mailing Address - Fax:
Practice Address - Street 1:30 NORTH WARDER STREET
Practice Address - Street 2:SUITE 165
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504
Practice Address - Country:US
Practice Address - Phone:937-717-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028614101Y00000X
TX66365101YP2500X
OHE. 1200737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor