Healthcare Provider Details

I. General information

NPI: 1174455448
Provider Name (Legal Business Name): EMILY ELIZABETH JORDAN AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5743 CORSA AVE
WESTLAKE VILLAGE CA
91362-4027
US

IV. Provider business mailing address

PO BOX 3681
THOUSAND OAKS CA
91359-0681
US

V. Phone/Fax

Practice location:
  • Phone: 818-643-1553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: