Healthcare Provider Details

I. General information

NPI: 1952205650
Provider Name (Legal Business Name): JORDAN IMHOFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BARNES RD
HYDE PARK VT
05655-9666
US

IV. Provider business mailing address

832 BARNES RD
HYDE PARK VT
05655-9666
US

V. Phone/Fax

Practice location:
  • Phone: 802-585-9350
  • Fax:
Mailing address:
  • Phone: 802-585-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JORDAN KYLE IMHOFF
Title or Position: LCMHC
Credential: MA COUNSELING
Phone: 802-585-9350