Individual
THERESA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2002
(318) 734-8232
Mailing address
721 STAG TRL, HAUGHTON, LA 71037-7700
(318) 380-3888
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8429
LA
101YM0800X
Mental Health Counselor
8429
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/22/2020
Last updated
09/26/2023
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