Provider Demographics
NPI:1376186031
Name:HOUGHTON, JORDAN GERALD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:GERALD
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 CORNELL AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2631
Mailing Address - Country:US
Mailing Address - Phone:206-898-7912
Mailing Address - Fax:
Practice Address - Street 1:12025 115TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6935
Practice Address - Country:US
Practice Address - Phone:425-821-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2023-02-09
Deactivation Date:2022-09-06
Deactivation Code:
Reactivation Date:2022-12-14
Provider Licenses
StateLicense IDTaxonomies
WAPY61291458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist