Provider Demographics
NPI:1982285466
Name:MCKENDALL, JORDAN ANTHONY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANTHONY
Last Name:MCKENDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6076
Mailing Address - Country:US
Mailing Address - Phone:504-717-0709
Mailing Address - Fax:
Practice Address - Street 1:3112 W PINHOOK RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3443
Practice Address - Country:US
Practice Address - Phone:337-703-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health