Provider Demographics
NPI:1659679686
Name:SAUNDERS, JORDANNA LAVINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JORDANNA
Middle Name:LAVINA
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JORDANNA
Other - Middle Name:LAVINA
Other - Last Name:BURKETT CRIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC LCPC
Mailing Address - Street 1:2990 N LITCHFIELD RD STE 7
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7800
Mailing Address - Country:US
Mailing Address - Phone:480-374-3523
Mailing Address - Fax:
Practice Address - Street 1:2990 N LITCHFIELD RD STE 7
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:602-626-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 2226101YP2500X
AZLPC-14035101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLCPC 2226OtherLICENSE
AZLPC-14035OtherLICENSE