Provider Demographics
NPI:1780001016
Name:JORDAN WEST FAMILY COUNSELING
Entity Type:Organization
Organization Name:JORDAN WEST FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCWS
Authorized Official - Phone:801-566-0749
Mailing Address - Street 1:9263 S REDWOOD RD
Mailing Address - Street 2:BUILDING 8 SUITE B
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6571
Mailing Address - Country:US
Mailing Address - Phone:801-566-0749
Mailing Address - Fax:
Practice Address - Street 1:9263 S REDWOOD RD
Practice Address - Street 2:BUILDING 8 SUITE B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6571
Practice Address - Country:US
Practice Address - Phone:801-566-0749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty