Provider Demographics
NPI:1740382266
Name:JORDAN, PAUL E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:JORDAN
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 1:19345 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2612
Mailing Address - Country:US
Mailing Address - Phone:206-542-6704
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW
Practice Address - Street 2:SUITE 211
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7641
Practice Address - Country:US
Practice Address - Phone:425-778-3200
Practice Address - Fax:425-778-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health