Provider Demographics
NPI:1720802580
Name:MCGRATH, JOURDAN D
Entity type:Individual
Prefix:
First Name:JOURDAN
Middle Name:D
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 POPPS FERRY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2309
Mailing Address - Country:US
Mailing Address - Phone:228-284-2644
Mailing Address - Fax:855-402-2013
Practice Address - Street 1:1636 POPPS FERRY RD STE 203
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2309
Practice Address - Country:US
Practice Address - Phone:228-284-2644
Practice Address - Fax:855-402-2013
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker