Individual
KEVIN MICHAEL JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
1827 W GENTRY PKWY, TYLER, TX 75702-3929
(903) 630-7461
Mailing address
715 ESTES DR, LONGVIEW, TX 75602-6102
(903) 900-2134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13944
TX
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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