Healthcare Provider Details

I. General information

NPI: 1437967353
Provider Name (Legal Business Name): JORDAN GULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST
WALLA WALLA WA
99362-1900
US

IV. Provider business mailing address

103 E MAIN ST
WALLA WALLA WA
99362-1900
US

V. Phone/Fax

Practice location:
  • Phone: 509-301-3270
  • Fax:
Mailing address:
  • Phone: 509-301-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHCA.70137446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: