Provider Demographics
NPI:1821604414
Name:MEYER, JORDAN (LCMHC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11762 S STATE ST STE 360
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7166
Mailing Address - Country:US
Mailing Address - Phone:801-571-6782
Mailing Address - Fax:801-438-3184
Practice Address - Street 1:11762 S STATE ST STE 360
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7166
Practice Address - Country:US
Practice Address - Phone:801-571-6782
Practice Address - Fax:801-438-3184
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10944825-6004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor