1649097338 NPI number — JESSICA BOYD JORDAN ATR-P, LPC-A

NPI Number: 1649097338
Health Care Provider/Practitioner: JESSICA BOYD JORDAN ATR-P, LPC-A

NPI Number : 1649097338 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649097338",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JORDAN",
    "FirstName": "JESSICA",
    "MiddleName": "BOYD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATR-P, LPC-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BOYD",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ART-P, LPC-A",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2092 HARRY BYRD HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DARLINGTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29532-6003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-639-1410",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "616 S COIT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLORENCE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29501-5223",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-674-0054",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2024",
    "LastUpdateDate": "06/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "221700000X",
          "TaxonomyName": "Art Therapist",
          "LicenseNumber": "24-693",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "10143",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}