Healthcare Provider Details

I. General information

NPI: 1730952532
Provider Name (Legal Business Name): JORDAN PFOST CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 3328
LOUISVILLE KY
40217-1415
US

IV. Provider business mailing address

1169 EASTERN PKWY STE 3328
LOUISVILLE KY
40217-1415
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number253693
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: