Individual
MR. JORDAN PHILLIP WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED PCC
Contact information
Practice address
2000 W BRIGGSMORE AVE, MODESTO, CA 95350-3839
(209) 526-1440
Mailing address
2000 W BRIGGSMORE AVE, BUILDING A, MODESTO, CA 95350-3839
(209) 679-3114
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
22034
CA
101YP2500X
Professional Counselor
Primary
12233
CA
Other
Enumeration date
07/21/2022
Last updated
04/03/2026
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