Healthcare Provider Details

I. General information

NPI: 1144951633
Provider Name (Legal Business Name): JORDAN GIDLEY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 CALIFORNIA AVE SW APT 210
SEATTLE WA
98136-1800
US

IV. Provider business mailing address

6312 CALIFORNIA AVE SW APT 210
SEATTLE WA
98136-1800
US

V. Phone/Fax

Practice location:
  • Phone: 440-725-7259
  • Fax:
Mailing address:
  • Phone: 206-200-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70131475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: