Provider Demographics
NPI:1063296747
Name:CRAFT, JORDAN L (PLPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:CRAFT
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:L
Other - Last Name:KOONTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-961-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:230 N BELCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6287
Practice Address - Country:US
Practice Address - Phone:417-413-4676
Practice Address - Fax:417-763-3308
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023042180101YP2500X
MO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional