Healthcare Provider Details

I. General information

NPI: 1558522417
Provider Name (Legal Business Name): GABRIELLE NICOLE JORDAN LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 SHALLOWFORD RD
CHATTANOOGA TN
37421-1688
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 800-255-6711
  • Fax:
Mailing address:
  • Phone: 800-255-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: