Provider Demographics
NPI:1386793016
Name:JORDAN BRACKETT, SANDRA (MFT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:JORDAN BRACKETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 OAK ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1388
Mailing Address - Country:US
Mailing Address - Phone:925-787-7494
Mailing Address - Fax:925-240-8193
Practice Address - Street 1:425 OAK ST
Practice Address - Street 2:SUITE C2
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1388
Practice Address - Country:US
Practice Address - Phone:925-787-7494
Practice Address - Fax:925-240-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist