Provider Demographics
NPI:1750886842
Name:WARTH, JORDAN (MS, NCC, LMHCA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WARTH
Suffix:
Gender:F
Credentials:MS, NCC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 FELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3514
Mailing Address - Country:US
Mailing Address - Phone:574-233-9491
Mailing Address - Fax:574-233-9616
Practice Address - Street 1:1102 FELLOWS ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3514
Practice Address - Country:US
Practice Address - Phone:574-233-9491
Practice Address - Fax:574-233-9616
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000500A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health