| Doctor Name: | MS. MANDY ANN JORDAN |
| NPI Number: | 1417254913 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CAC II |
| License Number: | 6988 |
| Business Practice Address: | 1004 Carbon Trinidad, CO - 810823664 |
| Business Phone Number: | 7198464153 |
| Business Fax Number: | |
| Mailing Address: | 1004 Carbon, TRINIDAD |
| State: | CO |
| Postal Code: | 810823664 |
| Phone Number: | 7198464153 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2011 |
| NPI Last Update Date: | 02/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6988 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |