Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003064460 |
---|---|
Provider Name | Mr. David B Jordan |
First Address | Springdale, AR 72762-0737 |
Second Address | Monticello, AR 71655-9663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |