Healthcare Provider Details

I. General information

NPI: 1205402724
Provider Name (Legal Business Name): JORDAN BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5391
US

IV. Provider business mailing address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5391
US

V. Phone/Fax

Practice location:
  • Phone: 855-329-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: