Provider Demographics
NPI:1689237588
Name:HA, JORDAN (AMFT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 E ORANGEWOOD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6138
Mailing Address - Country:US
Mailing Address - Phone:714-543-4333
Mailing Address - Fax:
Practice Address - Street 1:985 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4067
Practice Address - Country:US
Practice Address - Phone:949-646-3489
Practice Address - Fax:949-646-5148
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99120106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist