Provider Demographics
NPI:1033661426
Name:YARBROUGH, JORDAN K (MS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:K
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21606 REDBEAM AVE
Mailing Address - Street 2:1/2
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1770
Mailing Address - Country:US
Mailing Address - Phone:661-623-2563
Mailing Address - Fax:
Practice Address - Street 1:336 TEJON PL
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274
Practice Address - Country:US
Practice Address - Phone:562-673-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
CA108635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator