Provider Demographics
NPI:1992579866
Name:NYGARD, JORID (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JORID
Middle Name:
Last Name:NYGARD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11664 NATIONAL BLVD STE 277
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3802
Mailing Address - Country:US
Mailing Address - Phone:310-446-8612
Mailing Address - Fax:
Practice Address - Street 1:11664 NATIONAL BLVD STE 277
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3802
Practice Address - Country:US
Practice Address - Phone:310-446-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist