Provider Demographics
NPI:1588316707
Name:JORDAN MCGAHEE, ALICE DENISE (MS, RBT)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:DENISE
Last Name:JORDAN MCGAHEE
Suffix:
Gender:F
Credentials:MS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2725
Mailing Address - Country:US
Mailing Address - Phone:863-214-3476
Mailing Address - Fax:
Practice Address - Street 1:705 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2725
Practice Address - Country:US
Practice Address - Phone:863-214-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-197919106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician