Active NPI
Tyler Brooke Jordan, LPC
- Professional Counselor
- Flowood, MS
National Provider Identifier
1790453074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3124
- Practice address
- 344 Keyway Dr Ste a
Flowood, MS 39232-8825 - Phone
- (769) 214-0836
- NPI assigned
- Sep 1, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3124 | MS | Primary |
Addresses
Primary practice location
344 Keyway Dr Ste a
Flowood, MS 39232-8825
Mailing address
926 Willow Grande Cir
Brandon, MS 39047-8312
Phone (601) 941-7092
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3124 | MS | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spero Health of Kentucky, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- NPI 1982102109
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1790453074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 WILLOW GRANDE CIR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390478312",
"telephone_number": "601-941-7092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 KEYWAY DR STE A",
"city": "FLOWOOD",
"state": "MS",
"postal_code": "392328825",
"telephone_number": "769-214-0836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "TYLER",
"middle_name": "BROOKE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-01",
"last_updated": "2024-07-01",
"certification_date": "2021-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "3124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flowood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.