Provider Demographics
NPI:1861235053
Name:NORTHROP, JORDAN TIMOTHY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TIMOTHY
Last Name:NORTHROP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 N PARKWAY APT B6
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3036
Mailing Address - Country:US
Mailing Address - Phone:731-879-9212
Mailing Address - Fax:
Practice Address - Street 1:384 CARRIAGE HOUSE DR STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2268
Practice Address - Country:US
Practice Address - Phone:731-868-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health