Provider Demographics
NPI:1003901992
Name:JARDON, GLORIA I (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:I
Last Name:JARDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 712742
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92072-2742
Mailing Address - Country:US
Mailing Address - Phone:858-212-4244
Mailing Address - Fax:
Practice Address - Street 1:9820 WILLOW CREEK RD
Practice Address - Street 2:SUITE 245
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1112
Practice Address - Country:US
Practice Address - Phone:858-212-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9607Other9607
CA9607Other9607