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General NPI Number Information
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NPI Number | 1669911285
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Entity Type | Individual
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Provider Name | DEREK R. JORDAN
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Gender | Male
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 25 WHITNEY DR STE 122
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City | MILFORD
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State | OH
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Zip | 45150-8400
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Country | US
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Telephone | 513-941-4999
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Fax | 513-694-0168
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Provider Business Mailing Address
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Address Line | 6460 HARRISON AVE STE 200
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City | CINCINNATI
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State | OH
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Zip | 45247-7958
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Country | US
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Telephone | 513-941-4999
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Fax | 513-694-0168
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.121091
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161401
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCII.121091
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.1600018
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2303715-SUPV
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License Number State | OH
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