Marissa Jordan, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4767 Issued in TN

Practice address

268 Christian Church Rd Ste 2
Johnson City, TN 37615-4484

Phone

(423) 491-4202

Fax

(423) 388-4774

NPI assigned

Feb 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marissa Jordan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• G. Michael Pilcher, Inc.

  • Mental Health Counselor
  • Ormond Beach, FL
  • NPI 1205306313
  NPD (past)

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

{
    "created_epoch": "1456185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1215396916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 6TH ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376202212",
            "telephone_number": "423-573-6836",
            "fax_number": "423-388-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 CHRISTIAN CHURCH RD STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154484",
            "telephone_number": "423-491-4202",
            "fax_number": "423-388-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MARISSA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-23",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.1500150",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "4767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "JORDAN",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sydney R Jones, FNP-BC
• Sydney Witherspoon Jones
• Warren L Jones, CRNA
• Jonesborough Medical Center
• Louis Collier Jordan, MD
• Richard M Jordan, MD
• Joseph E. Bieberly, MD
• James Allen Joslyn, MD
• Ryan Kara Judson, NP
• Jennifer D Judy, PMHNP-BC

• Professional Counselor in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.