Mira Charlotte Jourdan, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014267 Issued in MI

Practice address

3361 36TH St SE
Kentwood, MI 49512-2809

Phone

(616) 942-2522

Fax

(616) 956-3260

NPI assigned

Jul 13, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mira Charlotte Krishnan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hope Network Behavioral Health Services

  dba Center for Autism

  • Child & Adolescent Psychiatry Physician
  • Grand Rapids, MI
  • NPI 1104128602
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1902194806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 BROOKLYN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495073937",
            "telephone_number": "248-885-4992",
            "fax_number": "616-825-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3361 36TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495122809",
            "telephone_number": "616-942-2522",
            "fax_number": "616-956-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOURDAN",
        "first_name": "MIRA",
        "middle_name": "CHARLOTTE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301014267",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRA",
            "last_name": "KRISHNAN",
            "middle_name": "CHARLOTTE",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan Renae Jonker
• Ariauna Marie Jordan, BEHAVIOR TECHNICIAN
• Heather Lynn Jordan, PA-C
• Nigel Wayne Jordon
• Joseph a. Rossi, D.D.S., P.C.
• Kabafusion of Mi, LLC (KabaFusion MI)
• Gabriela Kabandana
• Olivia M Kaercher
• Kaili Ball Counseling, LLC
• Heather Kaminski, PA

• Clinical Psychologist in Kentwood, MI
• Providers in Kentwood, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.