Doctor Name: | MR. JONATHAN BLAKE VARDELL |
NPI Number: | 1841637923 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C |
License Number: | 1453 |
Business Practice Address: | 1735 Sheridan Ave Suite 238 Cody, WY - 824143855 |
Business Phone Number: | 3078995456 |
Business Fax Number: | 3075276218 |
Mailing Address: | 1735 Sheridan Ave, Suite 238 CODY |
State: | WY |
Postal Code: | 824143855 |
Phone Number: | 3078995456 |
Fax Number: | |
NPI Enumeration Date: | 05/29/2013 |
NPI Last Update Date: | 01/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 1453 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |