Provider Demographics
NPI:1912447103
Name:HUSAIN, AYAZ (LMFT)
Entity type:Individual
Prefix:
First Name:AYAZ
Middle Name:
Last Name:HUSAIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14119 RUNNYMEDE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1433
Mailing Address - Country:US
Mailing Address - Phone:484-223-6143
Mailing Address - Fax:
Practice Address - Street 1:14119 RUNNYMEDE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1433
Practice Address - Country:US
Practice Address - Phone:484-223-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist