Provider Demographics
NPI:1861737959
Name:STRESS MANAGEMENT AND BIOFEEDBACK
Entity type:Organization
Organization Name:STRESS MANAGEMENT AND BIOFEEDBACK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JORDY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMHC
Authorized Official - Phone:360-255-0772
Mailing Address - Street 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 223
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-255-0772
Mailing Address - Fax:360-255-0773
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 223
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
Practice Address - Country:US
Practice Address - Phone:360-255-0772
Practice Address - Fax:360-255-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty