Provider Demographics
NPI:1053338608
Name:JORDETH, CATHERINE C (MS)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:JORDETH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 N 87TH PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4399
Mailing Address - Country:US
Mailing Address - Phone:480-998-9426
Mailing Address - Fax:480-657-9638
Practice Address - Street 1:8149 N 87TH PL
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:480-998-9426
Practice Address - Fax:480-657-9638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-0174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ081236Medicaid