MEDICARE: KIM YVETTE JORDAN LPCC-S

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	E.1100473-S	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558889212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM YVETTE JORDAN LPCC-S

Provider Business Mailing Address
First Line	:	2018 SYCAMORE DR
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-2314
Country	:	US
Telephone Number	:	216-246-9437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 SYCAMORE DR
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-2314
Country	:	US
Telephone Number	:	216-246-9437
Fax Number	:	216-250-8185

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	01/25/2023

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