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General NPI Number Information
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NPI Number | 1487285060
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Entity Type | Individual
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Provider Name | KTOYA JORDAN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 3803 HAINES RD N
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City | ST PETERSBURG
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State | FL
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Zip | 33703-5625
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Country | US
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Telephone | 727-373-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 3527 BEACH DR SE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33705-4101
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Country | US
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Telephone | 727-488-9615
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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