Healthcare Provider Details

I. General information

NPI: 1609594480
Provider Name (Legal Business Name): WHITNEY JORDAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 OLD SPENCER RD
BURNS TN
37029-5514
US

IV. Provider business mailing address

165 OLD SPENCER RD
BURNS TN
37029-5514
US

V. Phone/Fax

Practice location:
  • Phone: 901-937-9948
  • Fax: 901-937-9948
Mailing address:
  • Phone: 901-937-9948
  • Fax: 901-937-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: