Healthcare Provider Details

I. General information

NPI: 1437817855
Provider Name (Legal Business Name): KEVIN DANTE JORDAN AMFT #14785
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E MICHIGAN AVE
FRESNO CA
93704-5731
US

IV. Provider business mailing address

1617 W SHAW AVE STE B
FRESNO CA
93711-3507
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-3454
  • Fax:
Mailing address:
  • Phone: 559-347-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: