Provider Demographics
NPI:1457623647
Name:DAMM, JORDAN BRADFORD
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:BRADFORD
Last Name:DAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PROVIDENCE MINE RD
Mailing Address - Street 2:#105
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2947
Mailing Address - Country:US
Mailing Address - Phone:530-265-7844
Mailing Address - Fax:
Practice Address - Street 1:988 MCCOURTNEY RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7400
Practice Address - Country:US
Practice Address - Phone:530-955-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health