Mr Jordan Daniel Costello, is a
Counselor - Mental Health based in Maryville, Tennessee. Mr Jordan Daniel Costello is licensed to practice in * (Not Available) (license number ) and his current practice location is
1704 E Broadway Ave, Maryville, Tennessee. He can be reached at his office (for appointments etc.) via phone at
(865) 681-6990.
NPI number for Mr Jordan Daniel Costello is 1942085238 and his current mailing address is 200 Tech Center Dr, Knoxville, Tennessee. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1942085238.
Healthcare Provider's Profile
| Full Name | Mr Jordan Daniel Costello |
|---|
| Gender | Male |
|---|
| Speciality | Counselor - Mental Health |
|---|
| Location | 1704 E Broadway Ave, Maryville, Tennessee |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1942085238
- Provider Enumeration Date: 08/28/2023
- Last Update Date: 05/15/2024
Medical Identifiers
Medical identifiers for Mr Jordan Daniel Costello such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1942085238 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jordan Daniel Costello is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Jordan Daniel Costello,
200 Tech Center Dr,
Knoxville, TN 37912-2747
Ph: () - | Mr Jordan Daniel Costello,
1704 E Broadway Ave,
Maryville, TN 37804-2916
Ph: (865) 681-6990 |
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