Jennifer Diane Cordova, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

113271 Issued in CA

Practice address

590 Antelope Blvd Ste 40a
Red Bluff, CA 96080-2477

Phone

(530) 529-9454

Fax

(530) 529-9456

NPI assigned

Aug 1, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• N/a N/a N/a Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• His Ideas, Inc

  • Community/Behavioral Health Agency
  • Red Bluff, CA
  • NPI 1568641470
  NPD
• His Ideas, Inc

  • Foster Care Agency
  • Redding, CA
  • NPI 1386416774

  Mental Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1083138986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960800950",
            "telephone_number": "530-529-9454",
            "fax_number": "530-529-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 ANTELOPE BLVD STE 40A",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802477",
            "telephone_number": "530-529-9454",
            "fax_number": "530-529-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "JENNIFER",
        "middle_name": "DIANE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "71576",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "113271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083138986",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "530-529-9456",
            "affiliation": "N",
            "endpointDescription": "Fax",
            "address_1": "590 Antelope Blvd Ste 40A",
            "city": "Red Bluff",
            "state": "CA",
            "country_code": "US",
            "postal_code": "960802477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "credential": "LMFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Thomas M Coon, MD
• Carissa Ann Cooper
• Raven Cooper
• Catherine R Copeland, CRNA
• Elizabeth Cordero Orozco
• Debbie Cordray, ACSW
• Corporate Training Group
• Humberto Corrales
• Wanda Fay Cossairt, LCSW
• Peter John Cotsirilos Jr., M.D.

• All providers in Red Bluff, CA
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.