MEDICARE: BRIANISHA MARIA JORDAN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	133N00000X	Nutritionist
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225464779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANISHA MARIA JORDAN

Provider Business Mailing Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 120
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-600-9433
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 CAMINO AL NORTE
Second Line	:	SUITE 120
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2415
Country	:	US
Telephone Number	:	702-600-9433
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	10/04/2013

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Directions to “ BRIANISHA MARIA JORDAN ” Practice Location

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