MEDICARE: NICHOLAS BREWER JORDAN MA, 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	2020005149	MO

General Provider Information

NPI Number	:	1720667538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BREWER JORDAN MA, LPC

Provider Business Mailing Address
First Line	:	616 E 63RD ST STE 200A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-3371
Country	:	US
Telephone Number	:	816-514-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	6615 FLORA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1409
Country	:	US
Telephone Number	:	816-514-1087
Fax Number	:

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

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	09/27/2025

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