MEDICARE: DR. BRANDI JORDAN PHD, LMFT, LAADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	IMF80642	CA
2	106H00000X	Marriage & Family Therapist	98831	CA

General Provider Information

NPI Number	:	1316303514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDI JORDAN PHD, LMFT, LAADC

Provider Business Mailing Address
First Line	:	PO BOX 2128
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92885-1328
Country	:	US
Telephone Number	:	559-593-8817
Fax Number	:

Provider Business Practice Location Address
First Line	:	553 N MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2846
Country	:	US
Telephone Number	:	885-882-7473
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	11/12/2024

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