Provider Demographics
NPI:1467695791
Name:JORDAN, SELENA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 ALANWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1974
Mailing Address - Country:US
Mailing Address - Phone:619-944-2926
Mailing Address - Fax:
Practice Address - Street 1:2918 ALANWOOD CT
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1974
Practice Address - Country:US
Practice Address - Phone:619-944-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA #1084479103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst