MEDICARE: JORDAN TRINER LLPC

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	6401018251	MI

General Provider Information

NPI Number	:	1528688397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN TRINER LLPC

Provider Business Mailing Address
First Line	:	40087 DAY DR
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3028
Country	:	US
Telephone Number	:	586-504-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S STE A201
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5552
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:

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

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	04/22/2020

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