Provider Demographics
NPI:1508363680
Name:PARK, JORDAN (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N WALKER AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1233
Mailing Address - Country:US
Mailing Address - Phone:405-841-4800
Mailing Address - Fax:405-841-4803
Practice Address - Street 1:501 N WALKER AVE STE 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1233
Practice Address - Country:US
Practice Address - Phone:405-841-4800
Practice Address - Fax:405-841-4803
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist