Individual provider · Type 1 NPI

Jordan Daniel Costello

Mental Health Counselor · Maryville, TN

NPI number 1942085238 Active

Practice location

1704 E Broadway Ave
Maryville, TN 37804-2916

Mailing address

200 Tech Center Dr
Knoxville, TN 37912-2747

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker 1041C0700XNone listed
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1942085238

Jordan Daniel Costello's National Provider Identifier is 1942085238, issued on Aug 28, 2023. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Maryville, TN. The record was last updated on May 15, 2024.