Provider Demographics
NPI:1275029910
Name:KASSEL, JORDAN WILSON (LMFT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:WILSON
Last Name:KASSEL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 FOOTHILL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3269
Mailing Address - Country:US
Mailing Address - Phone:502-299-7369
Mailing Address - Fax:
Practice Address - Street 1:1150 FOOTHILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3269
Practice Address - Country:US
Practice Address - Phone:502-299-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120374106H00000X
CAAMFT108428106H00000X
CALMFT120374106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator