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NPI Code Detail

MEDICARE: JORDAN FREEMAN BA

MEDICARE: JORDAN FREEMAN BA
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1356231419
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN FREEMAN BA
Provider Business Mailing Address
First Line : 6709 INDEPENDENCE AVE APT 351
Second Line :
City : CANOGA PARK
State : CA
Zip : 91303-3744
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11900 W OLYMPIC BLVD STE 410
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1168
Country : US
Telephone Number : 424-229-2134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2025
Last Update Date : 07/08/2025

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