Healthcare Provider Details

I. General information

NPI: 1508537101
Provider Name (Legal Business Name): RACHAEL L JORDAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHAEL L JORDAN

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 E WALNUT ST
COLUMBIA MO
65201-6425
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-7500
  • Fax:
Mailing address:
  • Phone: 417-849-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019039844
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: