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General NPI Number Information
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NPI Number | 1922784073
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Entity Type | Individual
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Provider Name | JORDAN PATRICIA CARR LMHC-A
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Gender | Female
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 3804 HASTINGS AVE W
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-9642
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Country | US
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Telephone | 360-710-7302
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Fax |
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Provider Business Mailing Address
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Address Line | 6695 NE MAPLE ST
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City | SUQUAMISH
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State | WA
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Zip | 98392-9724
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Country | US
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Telephone | 360-710-7302
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61431881
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License Number State | WA
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