Basic Information
| Provider Information | |||||||||
| NPI: | 1912277922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYRES | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ASHLEY | ||||||||
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| Credential: | MFTI 68599 | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | AYRES | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 407 S GRAMERCY PL | ||||||||
| Address2: | APT. A | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900204964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182672624 | ||||||||
| FaxNumber: | 8182672710 | ||||||||
| Practice Location | |||||||||
| Address1: | 15339 SATICOY ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182672624 | ||||||||
| FaxNumber: | 8182672710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 68599 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.