Provider Demographics
NPI:1487137493
Name:DOOLEY, JORDYN (LPC-INTERN)
Entity type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3663
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-3500
Mailing Address - Country:US
Mailing Address - Phone:904-945-0781
Mailing Address - Fax:
Practice Address - Street 1:141 CITATION WAY
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-5103
Practice Address - Country:US
Practice Address - Phone:904-945-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-7015101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor