Doctor Name: | DR. LEWIS JAMES JORDAN |
NPI Number: | 1003904038 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. PHD, NCC, LMHC |
License Number: | MH-9760 |
Business Practice Address: | 398 Camino Gardens Blvd Suite 100 Boca Raton, FL - 334325827 |
Business Phone Number: | 9543992093 |
Business Fax Number: | 5616202972 |
Mailing Address: | 398 Camino Gardens Blvd, Suite 100 BOCA RATON |
State: | FL |
Postal Code: | 334325827 |
Phone Number: | 9543992093 |
Fax Number: | 5616202972 |
NPI Enumeration Date: | 10/11/2006 |
NPI Last Update Date: | 06/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH-9760 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |