Provider Demographics
NPI:1336811959
Name:GROENINK, JORDEN RAE
Entity type:Individual
Prefix:
First Name:JORDEN
Middle Name:RAE
Last Name:GROENINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDEN
Other - Middle Name:RAE
Other - Last Name:HARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4834 DONLON RD
Mailing Address - Street 2:
Mailing Address - City:SOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:93066-9766
Mailing Address - Country:US
Mailing Address - Phone:805-504-6945
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4265
Practice Address - Country:US
Practice Address - Phone:805-413-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health