Provider Demographics
NPI:1992255970
Name:JORDAN WEST FAMILY COUNSELING
Entity type:Organization
Organization Name:JORDAN WEST FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-566-0749
Mailing Address - Street 1:9263 S REDWOOD RD BLDG 8
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6571
Mailing Address - Country:US
Mailing Address - Phone:801-566-0749
Mailing Address - Fax:801-566-7108
Practice Address - Street 1:9263 S REDWOOD RD BLDG 8
Practice Address - Street 2:SUITE B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6571
Practice Address - Country:US
Practice Address - Phone:801-566-0749
Practice Address - Fax:801-566-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8003723-3501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty