Healthcare Provider Details

I. General information

NPI: 1992052971
Provider Name (Legal Business Name): JORDAN ZIPKIN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE 203
LOS ANGELES CA
90025
US

IV. Provider business mailing address

PO BOX 222061
HOLLYWOOD FL
33022-2061
US

V. Phone/Fax

Practice location:
  • Phone: 310-943-9663
  • Fax:
Mailing address:
  • Phone: 561-214-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84657
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT99954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: