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General NPI Number Information
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NPI Number | 1114578341
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Entity Type | Individual
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Provider Name | JENNIFER JORDAN LPCC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 9124 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-3518
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Country | US
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Telephone | 540-293-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 OVERLAND AVE APT 165
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City | LOS ANGELES
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State | CA
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Zip | 90034-6374
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Country | US
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Telephone | 540-293-4554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008366
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6505
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License Number State | CA
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