MEDICARE: JORDAN ROBERT REYNOLDS

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	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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	:	1568740405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ROBERT REYNOLDS

Provider Business Mailing Address
First Line	:	512 E 24TH ST
Second Line	:
City	:	TISHOMINGO
State	:	OK
Zip	:	73460-3214
Country	:	US
Telephone Number	:	580-399-7653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 HOPPE BLVD STE 6
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2319
Country	:	US
Telephone Number	:	580-399-7653
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	08/25/2024

Similar Medicare Providers

1003778853 — HANNAH BARRETT
Practice Location Address:

1300 HOPPE BLVD STE 3
ADA, OK
74820-2319

Practice Phone: 405-857-8280
Practice Fax:

1902768682 — JARRED VAUGHAN
Practice Location Address:

1300 HOPPE BLVD STE 3
ADA, OK
74820-2319

Practice Phone: 405-857-8280
Practice Fax:

1225069925 — MR. KENNETH LYNN GANDY MS, LPC
Practice Location Address:

1300 HOPPE BLVD STE 5
ADA, OK
74820-2319

Practice Phone: 580-436-1222
Practice Fax: 580-436-1333

1588968275 — CHICKASAW NATION - FAMILY SERVICES
Practice Location Address:

1300 HOPPE BLVD STE 1
ADA, OK
74820-2319

Practice Phone: 580-436-7211
Practice Fax: 580-272-5757

1518372929 — MS. STACY CAROL PREWITT B.A.
Practice Location Address:

1300 HOPPE BLVD STE 6
ADA, OK
74820-2319

Practice Phone: 580-436-1222
Practice Fax: 580-436-1333

1831563378 — JAHNA BUCKALOO M.S., LPC-U/S
Practice Location Address:

1300 HOPPE BLVD STE 4
ADA, OK
74820-2319

Practice Phone: 580-272-5170
Practice Fax:

Directions to “ JORDAN ROBERT REYNOLDS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.