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NPI Code Detail

MEDICARE: JORDAN WARTH MS, NCC, LMHCA

MEDICARE: JORDAN WARTH MS, NCC, LMHCA
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
1101YM0800XMental Health Counselor88000500AIN

General Provider Information

NPI Number : 1750886842
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WARTH MS, NCC, LMHCA
Provider Business Mailing Address
First Line : 1102 FELLOWS ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3514
Country : US
Telephone Number : 574-233-9491
Fax Number : 574-233-9616
Provider Business Practice Location Address
First Line : 1102 FELLOWS ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3514
Country : US
Telephone Number : 574-233-9491
Fax Number : 574-233-9616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2018
Last Update Date : 03/29/2018

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