Healthcare Provider Details

I. General information

NPI: 1336686542
Provider Name (Legal Business Name): RA JORDAN CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OSUNA RD NE STE H4
ALBUQUERQUE NM
87107-5955
US

IV. Provider business mailing address

320 OSUNA RD NE STE H4
ALBUQUERQUE NM
87107-5955
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-2778
  • Fax: 505-345-2878
Mailing address:
  • Phone: 505-345-2778
  • Fax: 505-345-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0106
License Number StateNM

VIII. Authorized Official

Name: MRS. ROSALIE A JORDAN
Title or Position: LPCC
Credential: M.A.
Phone: 505-345-2778