Healthcare Provider Details

I. General information

NPI: 1093388902
Provider Name (Legal Business Name): AYANA CHURN MA, LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-3669
  • Fax:
Mailing address:
  • Phone: 805-383-3669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: