Provider Demographics
NPI:1487440475
Name:CARR, JORDAN MCKENNA
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MCKENNA
Last Name:CARR
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 1:2685 CACTUS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-6712
Mailing Address - Country:US
Mailing Address - Phone:775-440-9457
Mailing Address - Fax:
Practice Address - Street 1:10345 PROFESSIONAL CIR STE 125
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3100
Practice Address - Country:US
Practice Address - Phone:775-332-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-427862106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician