Healthcare Provider Details

I. General information

NPI: 1235890765
Provider Name (Legal Business Name): ASHLEY ELIZABETH ROBERTS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 12593
SAN DIEGO CA
92112-3593
US

IV. Provider business mailing address

PO BOX 12593
SAN DIEGO CA
92112-3593
US

V. Phone/Fax

Practice location:
  • Phone: 619-535-1971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: