Healthcare Provider Details

I. General information

NPI: 1154959294
Provider Name (Legal Business Name): JORDAN LEIGH MCLANE LCDC-GA, OCPSA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN LEIGH BRYANT LCDCII

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

IV. Provider business mailing address

830 EZZARD CHARLES DR
CINCINNATI OH
45214-2525
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-6672
  • Fax:
Mailing address:
  • Phone: 513-381-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162902
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411350
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberOCPSA.162074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: