Blacktop, Jordan Michael

Blacktop, Jordan Michael is an individual health care provider with primary practice located at 281 Laclair St , Coos Bay OR 97420-2988. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Blacktop, Jordan Michael can be contacted via phone (541) 266-6700.

Contact Information

Primary practice address
281 Laclair St Coos Bay OR 97420-2988
Phone: (541) 266-6700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1225759566
LBN Legal business name Blacktop, Jordan Michael
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2022
Last updated Sep 6th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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