Provider Demographics
NPI:1528955689
Name:MUNK, JORDAN TAYLOR
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:TAYLOR
Last Name:MUNK
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 1:511 TRENIER DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9730
Mailing Address - Country:US
Mailing Address - Phone:702-239-7444
Mailing Address - Fax:
Practice Address - Street 1:9041 S PECOS RD STE 3900
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6601
Practice Address - Country:US
Practice Address - Phone:702-239-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBACB1291010106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician