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General NPI Number Information
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NPI Number | 1124975255
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Entity Type | Individual
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Provider Name | JORDAN CHRISTIAN CHARLES CPC-INTERN
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Gender | Male
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Dates
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Enumeration Date | 03/16/2026
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 2620 REGATTA DR STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89128-6892
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Country | US
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Telephone | 725-257-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 8020 PASADERA ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-4316
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Country | US
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Telephone | 720-750-1604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CI5689
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License Number State | NV
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