Provider Demographics
NPI:1649450206
Name:JORDAN, ELLEN CHRISTINE (MFT)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:CHRISTINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:CHRISTINE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:446 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4369
Mailing Address - Country:US
Mailing Address - Phone:707-824-8237
Mailing Address - Fax:707-824-8237
Practice Address - Street 1:446 S HIGH ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4369
Practice Address - Country:US
Practice Address - Phone:707-824-8237
Practice Address - Fax:707-824-8237
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health