Provider Demographics
NPI:1528736626
Name:HARRELL, JORDAN BLAKE (MS, LAMFT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAKE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MS, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 S 4000 W STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5729
Mailing Address - Country:US
Mailing Address - Phone:801-824-7230
Mailing Address - Fax:
Practice Address - Street 1:10432 S 4000 W STE B
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5729
Practice Address - Country:US
Practice Address - Phone:801-824-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12448182-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist