Provider Demographics
NPI:1669193488
Name:CAPELL, JORDYN
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:CAPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 E MAIN STREET
Mailing Address - Street 2:SUITE 100 B/C
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2571
Mailing Address - Country:US
Mailing Address - Phone:614-885-5020
Mailing Address - Fax:
Practice Address - Street 1:5330 E MAIN STREET
Practice Address - Street 2:SUITE 100 B/C
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2571
Practice Address - Country:US
Practice Address - Phone:614-885-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health