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General NPI Number Information
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NPI Number | 1780001016
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Entity Type | Organization
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Legal Business Name | JORDAN WEST FAMILY COUNSELING
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 9263 S REDWOOD RD BUILDING 8 SUITE B
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City | WEST JORDAN
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State | UT
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Zip | 84088-6571
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Country | US
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Telephone | 801-566-0749
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Fax |
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Provider Business Mailing Address
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Address Line | 9263 S REDWOOD RD BUILDING 8 SUITE B
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City | WEST JORDAN
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State | UT
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Zip | 84088-6571
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Country | US
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Telephone | 801-566-0749
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BETTY JO OWEN
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Credential | LCWS
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Telephone | 801-566-0749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 20725
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License Number State | UT
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