Individual
JORDAN GAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1169 EASTERN PKWY STE 2239, LOUISVILLE, KY 40217-1444
(502) 509-5628
Mailing address
1169 EASTERN PKWY STE 2239, LOUISVILLE, KY 40217-1444
(502) 509-5628
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
267298
KY
101YM0800X
Mental Health Counselor
267298
KY
101YP2500X
Professional Counselor
Primary
267298
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100714740
—
KY
Enumeration date
12/29/2017
Last updated
02/18/2025
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