Healthcare Provider Details

I. General information

NPI: 1457063539
Provider Name (Legal Business Name): JORDAN HARRISON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10618 BRECKENRIDGE DR
LITTLE ROCK AR
72211-1802
US

IV. Provider business mailing address

10618 BRECKENRIDGE DR
LITTLE ROCK AR
72211-1802
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-8600
  • Fax: 501-217-8636
Mailing address:
  • Phone: 501-217-8600
  • Fax: 501-217-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23046-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: