Provider Demographics
NPI:1114413952
Name:MORRISON, JORDAN (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MORRISON
Suffix:
Gender:M
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 N DUTTON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-7161
Mailing Address - Country:US
Mailing Address - Phone:707-525-1515
Mailing Address - Fax:
Practice Address - Street 1:1260 N DUTTON AVE STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-7161
Practice Address - Country:US
Practice Address - Phone:707-525-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105711106H00000X
CA133351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist