Provider Demographics
NPI:1568072551
Name:SINGLETON, JORDAN ALEXIS
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXIS
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 W LINCOLN AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-8245
Mailing Address - Country:US
Mailing Address - Phone:415-867-2543
Mailing Address - Fax:
Practice Address - Street 1:2250 E FOOTHILL BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3406
Practice Address - Country:US
Practice Address - Phone:626-744-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103977104100000X, 101YM0800X
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker