MEDICARE: JORDAN GUY LMFT

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	106H00000X	Marriage & Family Therapist	MF001497	PA

General Provider Information

NPI Number	:	1952002982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN GUY LMFT

Provider Business Mailing Address
First Line	:	31-7 REVERE RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-5313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 W SPARKS ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-1918
Country	:	US
Telephone Number	:	267-808-2649
Fax Number	:

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	02/04/2025

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