MEDICARE: JORDAN OMARION BOLDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		MI

General Provider Information

NPI Number	:	1023949971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN OMARION BOLDEN

Provider Business Mailing Address
First Line	:	492 HARRISON ST
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3124
Country	:	US
Telephone Number	:	256-597-7274
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 HARRISON ST
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3124
Country	:	US
Telephone Number	:	256-597-7274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ JORDAN OMARION BOLDEN ” Practice Location

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