Provider Demographics
NPI:1104001528
Name:JORDAN, CYNTHIA ADRIENNE (LMFT, MS, MARRIAGE)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ADRIENNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMFT, MS, MARRIAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 PEARL ST
Mailing Address - Street 2:OSLC OCP
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3541
Mailing Address - Country:US
Mailing Address - Phone:541-221-9514
Mailing Address - Fax:541-743-4369
Practice Address - Street 1:1170 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3541
Practice Address - Country:US
Practice Address - Phone:541-221-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORT0931106H00000X
WALF60465103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor