Healthcare Provider Details

I. General information

NPI: 1376455485
Provider Name (Legal Business Name): JORDAN RISKO FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 W OLYMPIC BLVD # 1250W
LOS ANGELES CA
90064-1149
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 1250W
LOS ANGELES CA
90064-1149
US

V. Phone/Fax

Practice location:
  • Phone: 818-538-4840
  • Fax:
Mailing address:
  • Phone: 818-538-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JORDAN RISKO
Title or Position: CEO
Credential: LMFT
Phone: 818-538-4840