Healthcare Provider Details

I. General information

NPI: 1598928889
Provider Name (Legal Business Name): JAMES B JORDAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES B JORDAN PH.D., LPCC

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 CERRILLOS RD STE E
SANTA FE NM
87501-3784
US

IV. Provider business mailing address

453 CERRILLOS RD., BLDG. E
SANTA FE NM
87501
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-6440
  • Fax: 505-699-6440
Mailing address:
  • Phone: 505-699-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0108141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: