Provider Demographics
NPI:1114769502
Name:HSU, ELLEN H (MBA, MA, AMFT, APCC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:HSU
Suffix:
Gender:F
Credentials:MBA, MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 MADERA ROAD, #358
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:213-309-5598
Mailing Address - Fax:
Practice Address - Street 1:615 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3301
Practice Address - Country:US
Practice Address - Phone:805-312-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16618101YM0800X
CAAMFT146942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC16618OtherCA BOARD OF BEHAVIORAL SCIENCES
CAAMFT146942OtherCA BOARD OF BEHAVIORAL SCIENCES