Provider Demographics
NPI:1982281481
Name:JORDAN, TINA MARIE (LPC, RPT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6566 N MARKSHEFFEL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-4252
Mailing Address - Country:US
Mailing Address - Phone:719-384-8700
Mailing Address - Fax:
Practice Address - Street 1:6566 N MARKSHEFFEL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-4252
Practice Address - Country:US
Practice Address - Phone:719-384-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0016372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional