Provider Demographics
NPI:1912277922
Name:AYRES, ELIZABETH ASHLEY (MFTI 68599)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:AYRES
Suffix:
Gender:F
Credentials:MFTI 68599
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:AYRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:407 S GRAMERCY PL
Mailing Address - Street 2:APT. A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4964
Mailing Address - Country:US
Mailing Address - Phone:818-267-2624
Mailing Address - Fax:818-267-2710
Practice Address - Street 1:15339 SATICOY ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3345
Practice Address - Country:US
Practice Address - Phone:818-267-2624
Practice Address - Fax:818-267-2710
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health