Provider Demographics
NPI:1477780542
Name:SEGAL, JORDANA L (MFT)
Entity Type:Individual
Prefix:MS
First Name:JORDANA
Middle Name:L
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-9928
Mailing Address - Country:US
Mailing Address - Phone:714-615-8217
Mailing Address - Fax:949-833-2230
Practice Address - Street 1:16782 VON KARMAN AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-9928
Practice Address - Country:US
Practice Address - Phone:714-615-8217
Practice Address - Fax:949-833-2230
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46711OtherLICENSED MARRIAGE AND FAMILY THERAPIST