Active NPI
Jordan Nicole Petitt, LMFT
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1417547753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 137462
- Practice address
- 2904 Rowena Ave
Los Angeles, CA 90039-2042 - Phone
- (818) 381-9723
- NPI assigned
- Jan 20, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 137462 | CA | Primary |
Addresses
Primary practice location
2904 Rowena Ave
Los Angeles, CA 90039-2042
Mailing address
848 N California St
Burbank, CA 91505-2919
Phone (818) 970-3539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 14, 2025 through Dec 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137462 | CA | MD | Interventional Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676160000000",
"number": "1417547753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "848 N CALIFORNIA ST",
"city": "BURBANK",
"state": "CA",
"postal_code": "915052919",
"telephone_number": "818-970-3539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2904 ROWENA AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900392042",
"telephone_number": "818-381-9723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITT",
"first_name": "JORDAN",
"middle_name": "NICOLE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-20",
"last_updated": "2023-02-12",
"certification_date": "2023-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "137462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.