Provider Demographics
NPI:1114688033
Name:JORDAN, SELINA L (LMFT)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2633
Mailing Address - Country:US
Mailing Address - Phone:909-993-7183
Mailing Address - Fax:
Practice Address - Street 1:7177 BROCKTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2633
Practice Address - Country:US
Practice Address - Phone:909-993-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT154210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist