| Isaiah Mantooth-jordan | |
|
1868 Niagara Falls Blvd Ste 308 Tonawanda NY 14150-6494 | |
| (716) 418-3885 | |
| Not Available |
| Full Name | Isaiah Mantooth-jordan |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1868 Niagara Falls Blvd Ste 308, Tonawanda, New York |
| Authorized Official Name and Position | Isaiah Mantooth-jordan (OWNER) |
| Authorized Official Contact | 7164183885 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Isaiah Mantooth-jordan 1868 Niagara Falls Blvd Ste 308 Tonawanda NY 14150-6494 Ph: (716) 418-3885 | Isaiah Mantooth-jordan 1868 Niagara Falls Blvd Ste 308 Tonawanda NY 14150-6494 Ph: (716) 418-3885 |
| NPI Number | 1922863174 |
|---|---|
| Provider Enumeration Date | 02/16/2024 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922863174 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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