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General NPI Number Information
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NPI Number | 1578384905
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Entity Type | Individual
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Provider Name | MS. NIA M JORDAN
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 396 S CALIFORNIA AVE UNIT 2213
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City | WEST COVINA
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State | CA
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Zip | 91793-3488
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Country | US
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Telephone | 213-634-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 W 157TH ST APT 4
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City | GARDENA
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State | CA
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Zip | 90249-4736
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Country | US
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Telephone | 310-678-8170
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | CA
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