Dr. Jordan Michael Blacktop, PhD
Counselor, Mental Health in Coos Bay, OR. Individual provider (NPI-1).
NPI number1225759566
StatusActive
Last updated in NPPESSep 6, 2022
Details
- NPI
- 1225759566
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jordan Michael Blacktop
- Credential
- PhD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 6, 2022
- Certification date
- Sep 6, 2022
- Last updated
- Sep 6, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
| 171M00000X | Case Manager/Care Coordinator | – | – |
Practice location
281 Laclair StCoos Bay, OR 97420-2988
Phone 541-266-6700
Mailing address
281 Laclair StCoos Bay, OR 97420-2988
Phone 541-266-6700
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