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General NPI Number Information
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NPI Number | 1275736159
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Entity Type | Individual
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Provider Name | CYNTHIA A JORDAN MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1719 MERRILL DR
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City | LITTLE ROCK
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State | AR
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Zip | 72212-4009
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Country | US
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Telephone | 501-663-2199
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Fax | 501-663-2234
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Provider Business Mailing Address
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Address Line | 814 W CENTER ST
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City | SHERIDAN
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State | AR
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Zip | 72150-8402
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Country | US
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Telephone | 870-484-3938
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Fax | 870-942-3960
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0507050
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License Number State | AR
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