Provider Demographics
NPI:1154928117
Name:GERICKE, JORDAN (LPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GERICKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6702 KEATON CORPORATE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8630
Mailing Address - Country:US
Mailing Address - Phone:636-486-6965
Mailing Address - Fax:
Practice Address - Street 1:6702 KEATON CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8613
Practice Address - Country:US
Practice Address - Phone:636-486-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health