Provider Demographics
NPI:1316303514
Name:JORDAN, BRANDI (PHD, LMFT, LAADC)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD, LMFT, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-1328
Mailing Address - Country:US
Mailing Address - Phone:559-593-8817
Mailing Address - Fax:
Practice Address - Street 1:553 N MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-2846
Practice Address - Country:US
Practice Address - Phone:885-882-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF80642101YA0400X
CA98831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)