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NPI Code Detail

MEDICARE: JORDAN KRUCE

MEDICARE: JORDAN KRUCE
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 Counselor

General Provider Information

NPI Number : 1831949726
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN KRUCE
Provider Business Mailing Address
First Line : 1521 WILMA RUDOLPH BLVD APT 4
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-6732
Country : US
Telephone Number : 402-430-7450
Fax Number :
Provider Business Practice Location Address
First Line : 223 DUNBAR CAVE RD
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-8830
Country : US
Telephone Number : 931-444-3219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2024
Last Update Date : 03/25/2024

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