Provider Demographics
NPI:1437817855
Name:JORDAN, KEVIN DANTE (AMFT #14785)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DANTE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:AMFT #14785
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 W SHAW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3507
Mailing Address - Country:US
Mailing Address - Phone:559-347-7627
Mailing Address - Fax:
Practice Address - Street 1:1224 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-5731
Practice Address - Country:US
Practice Address - Phone:559-227-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147895106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist