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General NPI Number Information
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NPI Number | 1023357126
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Entity Type | Individual
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Provider Name | ANDREA JORDAN LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1101 BROADWAY ST STE 230
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City | VANCOUVER
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State | WA
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Zip | 98660-3320
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Country | US
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Telephone | 360-904-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 9911 NE 86TH WAY
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City | VANCOUVER
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State | WA
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Zip | 98662-2119
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Country | US
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Telephone | 360-904-0741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MC60220329
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License Number State | WA
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