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General NPI Number Information
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NPI Number | 1518567429
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Entity Type | Individual
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Provider Name | JORDAN LEE BIRKLAND PLMHP
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 230 E 22ND ST STE 4
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City | FREMONT
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State | NE
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Zip | 68025-2661
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Country | US
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Telephone | 402-727-4288
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Fax |
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Provider Business Mailing Address
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Address Line | 3014 PADDOCK RD APT 17B
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City | OMAHA
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State | NE
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Zip | 68124-2941
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Country | US
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Telephone | 319-383-4595
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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 | 12323
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License Number State | NE
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