Provider Demographics
NPI:1861610313
Name:JORDAN, MOREEN
Entity type:Individual
Prefix:MS
First Name:MOREEN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31603
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1603
Mailing Address - Country:US
Mailing Address - Phone:520-869-7052
Mailing Address - Fax:520-303-9205
Practice Address - Street 1:7301 E 22ND ST
Practice Address - Street 2:SUITE 10-E
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6426
Practice Address - Country:US
Practice Address - Phone:520-869-7052
Practice Address - Fax:520-303-2905
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10407101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional