Healthcare Provider Details

I. General information

NPI: 1366347619
Provider Name (Legal Business Name): JOURDAN OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 EARL ST
OAKLAND CA
94605-3632
US

IV. Provider business mailing address

7940 EARL ST
OAKLAND CA
94605-3632
US

V. Phone/Fax

Practice location:
  • Phone: 323-273-1663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: