Provider Demographics
NPI:1457236952
Name:JORDAN, DAPHNE JEANETTE
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:JEANETTE
Last Name:JORDAN
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 1:1228 SHORT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-4763
Mailing Address - Country:US
Mailing Address - Phone:931-212-4584
Mailing Address - Fax:
Practice Address - Street 1:705 HOWELL ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1057
Practice Address - Country:US
Practice Address - Phone:931-510-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health