Provider Demographics
NPI:1225760416
Name:LONG, JORDAN CLAIRE (MSW, LMHCA, LSWAIC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CLAIRE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW, LMHCA, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4328
Mailing Address - Country:US
Mailing Address - Phone:425-405-2216
Mailing Address - Fax:
Practice Address - Street 1:1720 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4328
Practice Address - Country:US
Practice Address - Phone:425-405-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609518651041C0700X
WAMC61327957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical