Provider Demographics
NPI:1952465486
Name:JORDAN, NATHANIEL (MS)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2101
Mailing Address - Country:US
Mailing Address - Phone:415-648-5785
Mailing Address - Fax:415-695-9830
Practice Address - Street 1:4301 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2101
Practice Address - Country:US
Practice Address - Phone:415-648-5785
Practice Address - Fax:415-695-9830
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health