Provider Demographics
NPI:1689111668
Name:JORDISON, AMY HUYNH (MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HUYNH
Last Name:JORDISON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:T
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 QUAIL ST STE 180
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2730
Mailing Address - Country:US
Mailing Address - Phone:949-562-3085
Mailing Address - Fax:
Practice Address - Street 1:1400 QUAIL ST STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2730
Practice Address - Country:US
Practice Address - Phone:949-562-3085
Practice Address - Fax:949-419-3458
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113126106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator