Provider Demographics
NPI:1831434166
Name:JORDAN, SARA (MA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6303 OWENSMOUTH AVE
Mailing Address - Street 2:FLOOR 10
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2264
Mailing Address - Country:US
Mailing Address - Phone:323-391-1622
Mailing Address - Fax:323-391-1622
Practice Address - Street 1:6303 OWENSMOUTH AVE
Practice Address - Street 2:FLOOR 10
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2264
Practice Address - Country:US
Practice Address - Phone:323-391-1622
Practice Address - Fax:323-391-1622
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool