Healthcare Provider Details

I. General information

NPI: 1336471630
Provider Name (Legal Business Name): MARY E. JORDAN-CHURCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 MAINE AVE
CLOVIS CA
93619-9288
US

IV. Provider business mailing address

2942 MAINE AVE
CLOVIS CA
93619-9288
US

V. Phone/Fax

Practice location:
  • Phone: 559-259-4481
  • Fax:
Mailing address:
  • Phone: 559-251-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 24068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: