Provider Demographics
NPI:1184467185
Name:MCGEE, JUPITER JORDYN
Entity type:Individual
Prefix:
First Name:JUPITER
Middle Name:JORDYN
Last Name:MCGEE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:KENDRICK
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9614 E HEROY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206-7039
Mailing Address - Country:US
Mailing Address - Phone:509-209-6227
Mailing Address - Fax:
Practice Address - Street 1:9614 E HEROY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99206-7039
Practice Address - Country:US
Practice Address - Phone:509-209-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61566036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health