Provider Demographics
NPI:1497244636
Name:PATE-GARRETT, JORDAN (LMHC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:PATE-GARRETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6928 SW 39TH ST APT A304
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2472
Mailing Address - Country:US
Mailing Address - Phone:954-543-1848
Mailing Address - Fax:
Practice Address - Street 1:4781 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0906
Practice Address - Country:US
Practice Address - Phone:530-584-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19266101YM0800X
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health