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NPI Code Detail

MEDICARE: MRS. JENNIFER JORDAN LPCC, LMHC

MEDICARE: MRS. JENNIFER JORDAN LPCC, LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor008366NY
2101YM0800XMental Health Counselor6505CA

General Provider Information

NPI Number : 1114578341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER JORDAN LPCC, LMHC
Provider Business Mailing Address
First Line : 3701 OVERLAND AVE APT 165
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-6374
Country : US
Telephone Number : 540-293-4554
Fax Number :
Provider Business Practice Location Address
First Line : 9124 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-3518
Country : US
Telephone Number : 540-293-4554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2019
Last Update Date : 11/12/2019

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