MEDICARE: JORDAN ROSSI LPC

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	101YP2500X	Professional Counselor	83169	TX
2	101YM0800X	Mental Health Counselor	83169	TX

General Provider Information

NPI Number	:	1467236703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ROSSI LPC

Provider Business Mailing Address
First Line	:	4425 S MOPAC EXPY
Second Line	:	BUILDING 2, SUITE 105
City	:	AUSTIN
State	:	TX
Zip	:	78735-6723
Country	:	US
Telephone Number	:	512-761-7762
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 S MOPAC EXPWY
Second Line	:	BUILDING 2, SUITE 105
City	:	AUSTIN
State	:	TX
Zip	:	78735-6723
Country	:	US
Telephone Number	:	512-761-7762
Fax Number	:

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/05/2024

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Directions to “ JORDAN ROSSI LPC” Practice Location

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