Provider Demographics
NPI:1952647562
Name:JORDAN, SHERI RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:RAE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:RAE
Other - Last Name:TULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5835
Mailing Address - Country:US
Mailing Address - Phone:505-402-8291
Mailing Address - Fax:
Practice Address - Street 1:313 W APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5835
Practice Address - Country:US
Practice Address - Phone:505-325-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0155671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health