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NPI Code Detail

MEDICARE: SAMANTHA JORDAN LAC

MEDICARE: SAMANTHA JORDAN LAC
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
1101YM0800XMental Health Counselor23774AZ

General Provider Information

NPI Number : 1083552285
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JORDAN LAC
Provider Business Mailing Address
First Line : 1375 N SCOTTSDALE RD STE 200
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85257-3429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1375 N SCOTTSDALE RD STE 200
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85257-3429
Country : US
Telephone Number : 480-877-9284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ SAMANTHA JORDAN LAC” Practice Location

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