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General NPI Number Information
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NPI Number | 1649751967
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Entity Type | Individual
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Provider Name | CAITLIN JORDAN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 32 WESTWOODS DR
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City | LIBERTY
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State | MO
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Zip | 64068-3519
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Country | US
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Telephone | 913-991-1857
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 NE PARVIN RD APT 205
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City | KANSAS CITY
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State | MO
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Zip | 64116-5019
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Country | US
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Telephone | 913-991-1857
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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 | 2010041801
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License Number State | MO
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