Healthcare Provider Details

I. General information

NPI: 1043641574
Provider Name (Legal Business Name): JENNIFER ANN JORDAN PHD, LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 JUNIPER TRCE
PARRISH FL
34219-8914
US

IV. Provider business mailing address

146 JUNIPER TRCE
PARRISH FL
34219-8914
US

V. Phone/Fax

Practice location:
  • Phone: 941-212-9162
  • Fax:
Mailing address:
  • Phone: 941-212-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 13353
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01150700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21805
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11268
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH 13353
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014741
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: