Provider Demographics
NPI:1609177906
Name:HOLE LAI, JORDAN (BA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HOLE LAI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 COLBY AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3557
Mailing Address - Country:US
Mailing Address - Phone:425-257-1621
Mailing Address - Fax:425-257-1767
Practice Address - Street 1:2722 COLBY AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3557
Practice Address - Country:US
Practice Address - Phone:425-257-1621
Practice Address - Fax:425-257-1767
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health