Provider Demographics
NPI:1851493738
Name:JORDAN, BETTI JEAN (RC00035276)
Entity Type:Individual
Prefix:MS
First Name:BETTI
Middle Name:JEAN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RC00035276
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 NW COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4416
Mailing Address - Country:US
Mailing Address - Phone:360-675-0339
Mailing Address - Fax:
Practice Address - Street 1:5801 23RD DR W STE 104
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1587
Practice Address - Country:US
Practice Address - Phone:425-513-8213
Practice Address - Fax:425-513-5034
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00035276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health