MEDICARE: NICOLE ASHTON M.A., MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC #45884	CA

General Provider Information

NPI Number	:	1093922585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ASHTON M.A., MFT

Provider Business Mailing Address
First Line	:	2550 OVERLAND AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3346
Country	:	US
Telephone Number	:	310-592-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 OVERLAND AVE
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3346
Country	:	US
Telephone Number	:	310-592-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	06/16/2010

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