Provider Demographics
NPI:1902623911
Name:JORDAN AUSTIN, SALLY (MFT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:JORDAN AUSTIN
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 1:1433 MARCELINA AVE # 42
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3258
Mailing Address - Country:US
Mailing Address - Phone:310-968-3035
Mailing Address - Fax:
Practice Address - Street 1:26838 CLAUDETTE ST UNIT 226
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-5217
Practice Address - Country:US
Practice Address - Phone:310-968-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist