Individual
JORDAN SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
135 W MAIN ST, CHEHALIS, WA 98532-4817
(360) 748-4339
Mailing address
615B KOONTZ RD, CHEHALIS, WA 98532-8436
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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