Healthcare Provider Details

I. General information

NPI: 1740897750
Provider Name (Legal Business Name): JORDAN TAIT BUCHANAN LH61333620
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 4TH AVE STE 860
SEATTLE WA
98121-4501
US

IV. Provider business mailing address

2033 6TH AVE STE 826
SEATTLE WA
98121-2593
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-7509
  • Fax:
Mailing address:
  • Phone: 206-414-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61333620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: