Healthcare Provider Details

I. General information

NPI: 1275283673
Provider Name (Legal Business Name): JORDAN YEE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E GARVEY AVE N STE B17
WEST COVINA CA
91791-1545
US

IV. Provider business mailing address

613 S 5TH AVE APT D
ARCADIA CA
91006-3961
US

V. Phone/Fax

Practice location:
  • Phone: 626-489-9114
  • Fax:
Mailing address:
  • Phone: 626-466-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: