Provider Demographics
NPI:1558946038
Name:JORDAN WITT, PH.D. PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:JORDAN WITT, PH.D. PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-564-1763
Mailing Address - Street 1:1531 CHAPALA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3047
Mailing Address - Country:US
Mailing Address - Phone:805-564-1763
Mailing Address - Fax:855-485-3130
Practice Address - Street 1:1531 CHAPALA ST STE 2
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3047
Practice Address - Country:US
Practice Address - Phone:805-564-1763
Practice Address - Fax:855-485-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty