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General NPI Number Information
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NPI Number | 1417547753
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Entity Type | Individual
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Provider Name | JORDAN NICOLE PETITT LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 02/12/2023
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Provider Practice Location Address
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Address Line | 2904 ROWENA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90039-2042
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Country | US
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Telephone | 818-381-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 848 N CALIFORNIA ST
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City | BURBANK
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State | CA
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Zip | 91505-2919
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Country | US
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Telephone | 818-970-3539
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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 | 137462
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License Number State | CA
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