MEDICARE: COURTNEY B JORDAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	14225371-3501	UT
2	1041C0700X	Clinical Social Worker	9664-C	NV

General Provider Information

NPI Number	:	1003475260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY B JORDAN LCSW

Provider Business Mailing Address
First Line	:	9300 SPRUCE MOUNTAIN WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6016
Country	:	US
Telephone Number	:	623-703-4754
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 SPRUCE MOUNTAIN WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6016
Country	:	US
Telephone Number	:	623-703-4754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	03/25/2026

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