Active NPI
Jordan Martin, MA, NCC, LPC
- Professional Counselor
- Marina del Rey, CA
National Provider Identifier
1225645807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC012365
- Practice address
- 4065 Glencoe Ave
Marina del Rey, CA 90292-4600 - Phone
- (610) 570-4507
- NPI assigned
- Sep 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC012365 | PA | Primary |
Addresses
Primary practice location
4065 Glencoe Ave
Marina del Rey, CA 90292-4600
Mailing address
4065 Glencoe Ave Apt 310
Marina del Rey, CA 90292-6079
Phone (610) 570-4507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC012365 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601251200000",
"number": "1225645807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4065 GLENCOE AVE APT 310",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902926079",
"telephone_number": "610-570-4507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4065 GLENCOE AVE",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902924600",
"telephone_number": "610-570-4507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JORDAN",
"credential": "MA, NCC, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-28",
"last_updated": "2020-09-28",
"certification_date": "2020-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC012365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina del Rey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.