Individual
DIANE EVELYN JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, NCC, LAC
Contact information
Practice address
3255 LT MOSS RD, MISSOULA, MT 59804-7220
(406) 532-9800
Mailing address
1325 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-9800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3323
MT
101YM0800X
Mental Health Counselor
Primary
7932
MT
Other
Enumeration date
02/19/2014
Last updated
11/01/2016
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