=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720803158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEATHER M JORDAN MARRIAGE AND FAMILY COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1452 OREGON ST STE 101
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-604-2450
-----------------------------------------------------
Fax | 530-232-2205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1452 OREGON ST STE 101
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-604-2450
-----------------------------------------------------
Fax | 530-232-2205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HEATHER MARYPATRICE JORDAN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 530-604-2450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------