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NPI Code Detail

MEDICARE: MATTHEW DAVID JORDAN M.S., LMFTA

MEDICARE: MATTHEW DAVID JORDAN M.S., LMFTA
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
1106H00000XMarriage & Family Therapist201064TX
2106H00000XMarriage & Family Therapist2633-RNV

General Provider Information

NPI Number : 1568672418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW DAVID JORDAN M.S., LMFTA
Provider Business Mailing Address
First Line : 3035 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3035 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2200
Country : US
Telephone Number : 806-775-1823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 01/13/2024

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