MEDICARE: JORDAN GULL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMHCA.70137446	WA

General Provider Information

NPI Number	:	1437967353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN GULL

Provider Business Mailing Address
First Line	:	103 E MAIN ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-1900
Country	:	US
Telephone Number	:	509-301-3270
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 E MAIN ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-1900
Country	:	US
Telephone Number	:	509-301-3270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	06/03/2026

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Directions to “ JORDAN GULL ” Practice Location

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