Provider Demographics
NPI:1285918508
Name:MULDER, JORDAN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE
Last Name:MULDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 BLUE RAVINE RD
Mailing Address - Street 2:#170
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4756
Mailing Address - Country:US
Mailing Address - Phone:916-608-0714
Mailing Address - Fax:916-608-0717
Practice Address - Street 1:193 BLUE RAVINE RD
Practice Address - Street 2:#170
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4756
Practice Address - Country:US
Practice Address - Phone:916-608-0714
Practice Address - Fax:916-608-0717
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist