Active NPI
Todd Micheal Jordan, LBA, LPC
- Professional Counselor
- Poplar Bluff, MO
National Provider Identifier
1316495302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2014028525
- Practice address
- 2451 Fair St
Poplar Bluff, MO 63901-7019 - Phone
- (573) 429-4810
- NPI assigned
- Sep 19, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Professional Counselor | 101YP2500X | 2014028525 | Primary |
Addresses
Primary practice location
2451 Fair St
Poplar Bluff, MO 63901-7019
Mailing address
2451 Fair St
Poplar Bluff, MO 63901-7019
Phone (573) 429-4810
Other practice location 1
101 S Main St
Poplar Bluff, MO 63901-5843
Phone (573) 686-5090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1316495302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2451 FAIR ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639017019",
"telephone_number": "573-429-4810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2451 FAIR ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639017019",
"telephone_number": "573-429-4810"
}
],
"practiceLocations": [
{
"address_1": "101 S Main St",
"address_purpose": "LOCATION",
"city": "Poplar Bluff",
"state": "MO",
"postal_code": "639015843",
"country_code": "US",
"telephone_number": "573-686-5090",
"fax_number": "573-785-4104",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JORDAN",
"first_name": "TODD",
"middle_name": "MICHEAL",
"credential": "LBA, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": "2014028525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- 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.