Provider Demographics
NPI:1548937824
Name:HUETTL, JORDAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:HUETTL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AIRPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2822
Mailing Address - Country:US
Mailing Address - Phone:850-424-5210
Mailing Address - Fax:850-424-3220
Practice Address - Street 1:1008 AIRPORT RD STE D
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2822
Practice Address - Country:US
Practice Address - Phone:850-424-5210
Practice Address - Fax:850-424-3220
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW188451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW18845OtherLICENSE