Healthcare Provider Details

I. General information

NPI: 1801469796
Provider Name (Legal Business Name): JORDAN STEVENSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DEXTER AVE
ERIE PA
16504-2444
US

IV. Provider business mailing address

3169 W 40TH ST
ERIE PA
16506-5309
US

V. Phone/Fax

Practice location:
  • Phone: 814-825-2930
  • Fax: 814-825-2964
Mailing address:
  • Phone: 330-766-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013427
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: