Active NPI
Nicole Andrews Jordan, LPC
- Professional Counselor
- Brandon, MS
National Provider Identifier
1881433266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3052
- Practice address
- 476 Pinebrook Cir
Brandon, MS 39047-7830 - Phone
- (601) 214-5800
- NPI assigned
- May 23, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | 3052 | MS | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X |
Addresses
Primary practice location
476 Pinebrook Cir
Brandon, MS 39047-7830
Mailing address
476 Pinebrook Cir
Brandon, MS 39047-7830
Phone (601) 214-5800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 29, 2024 through Aug 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3052 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717632000000",
"number": "1881433266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "476 PINEBROOK CIR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390477830",
"telephone_number": "601-214-5800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "476 PINEBROOK CIR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390477830",
"telephone_number": "601-214-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "NICOLE",
"middle_name": "ANDREWS",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-23",
"last_updated": "2024-06-06",
"certification_date": "2024-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "MS",
"license": "3052",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.