Provider Demographics
NPI:1356126619
Name:JORDAN, JANE (MFT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY JANE
Other - Middle Name:MCINTOSH
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2110 N MANTLE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7612
Mailing Address - Country:US
Mailing Address - Phone:714-834-1105
Mailing Address - Fax:
Practice Address - Street 1:2110 N MANTLE LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7612
Practice Address - Country:US
Practice Address - Phone:714-834-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist