Provider Demographics
NPI:1417793837
Name:SANDERS, JORDAN PATRICK (LMHC; LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:PATRICK
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LMHC; LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 TERRA GLENN ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8793
Mailing Address - Country:US
Mailing Address - Phone:615-569-8282
Mailing Address - Fax:
Practice Address - Street 1:10102 TERRA GLENN ST SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8793
Practice Address - Country:US
Practice Address - Phone:615-569-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6490101YM0800X
WAMHC.LH.61684577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health