Jordan B Killpack, MC, LPC, CMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

20280 Issued in TX

Practice address

2650 W 2700 S
Syracuse, UT 84075-9013

Phone

(956) 639-6309

Fax

(956) 639-6309

NPI assigned

Jun 19, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summitview Behavioral Health PLLC

  • Professional Counselor
  • Brownsville, TX
  • NPI 1538475595
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194760363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 W 2700 S",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759013",
            "telephone_number": "956-639-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 W 2700 S",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759013",
            "telephone_number": "956-639-6309",
            "fax_number": "956-639-6309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "934 S Main St",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840417135",
            "country_code": "US",
            "telephone_number": "801-773-7060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILLPACK",
        "first_name": "JORDAN",
        "middle_name": "B",
        "credential": "MC, LPC, CMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "UT",
            "license": "5422738-6004",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "20280",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "5422738-6004",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "20280",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "5422738-6004",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "20280",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "UT",
            "license": "5422738-6004",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "20280",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7489LC",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Ruth Kalmar
• Dylan Kaminske
• Max G Karabachian
• Kids Town Pediatric Dentistry of Syracuse
• Kidz Dental Works
• Aaron Franklin King, PHARMD
• Julie Ann Knopp, CSW
• Amber Lynne Kreiser
• Jerin H Lake
• Lakeshore Counseling

• Mental Health Counselor in Syracuse, UT
• Providers in Syracuse, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.