Provider Demographics
NPI:1902245665
Name:COLES, JORDAN (LPCC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:COLES
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 28TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4420
Mailing Address - Country:US
Mailing Address - Phone:218-512-0630
Mailing Address - Fax:218-329-2437
Practice Address - Street 1:1132 28TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4420
Practice Address - Country:US
Practice Address - Phone:218-512-0630
Practice Address - Fax:218-512-0437
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health