Provider Demographics
NPI:1700097250
Name:JORDAN, TRISHA A (MA, CRC)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, CRC
Other - Prefix:MISS
Other - First Name:TRISHA
Other - Middle Name:A
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1975 MCPHERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-751-2521
Mailing Address - Fax:541-751-2661
Practice Address - Street 1:1975 MCPHERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3482
Practice Address - Country:US
Practice Address - Phone:541-751-2521
Practice Address - Fax:541-751-2661
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter