Healthcare Provider Details

I. General information

NPI: 1821647546
Provider Name (Legal Business Name): JORDAN TIMMONS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

IV. Provider business mailing address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

V. Phone/Fax

Practice location:
  • Phone: 612-492-1624
  • Fax: 651-300-2702
Mailing address:
  • Phone: 612-492-1624
  • Fax: 651-300-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: