Healthcare Provider Details

I. General information

NPI: 1356254023
Provider Name (Legal Business Name): JORDAN WOLFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 DEERFIELD RD
LEBANON OH
45036-9946
US

IV. Provider business mailing address

1879 DEERFIELD RD
LEBANON OH
45036-9946
US

V. Phone/Fax

Practice location:
  • Phone: 513-695-2900
  • Fax: 513-809-1008
Mailing address:
  • Phone: 513-695-2900
  • Fax: 513-809-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608669
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: