Provider Demographics
NPI:1285147397
Name:JORDAN, JUANA LEIA (EDD)
Entity type:Individual
Prefix:DR
First Name:JUANA
Middle Name:LEIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:JUANA
Other - Middle Name:LEIA
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:3792 FLOWERING PEACH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4362
Mailing Address - Country:US
Mailing Address - Phone:702-286-8921
Mailing Address - Fax:702-458-0923
Practice Address - Street 1:3792 FLOWERING PEACH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4362
Practice Address - Country:US
Practice Address - Phone:702-286-8921
Practice Address - Fax:702-458-0923
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional