Provider Demographics
NPI:1699289074
Name:CHRISMAN, JORDAN MICHAL
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHAL
Last Name:CHRISMAN
Suffix:
Gender:M
Credentials:
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 903513
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-3513
Mailing Address - Country:US
Mailing Address - Phone:626-861-7234
Mailing Address - Fax:
Practice Address - Street 1:42011 4TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7185
Practice Address - Country:US
Practice Address - Phone:661-483-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT132015106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist