Healthcare Provider Details

I. General information

NPI: 1285409151
Provider Name (Legal Business Name): ASHLEY MICHELLE BRETT AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

V. Phone/Fax

Practice location:
  • Phone: 805-582-4080
  • Fax:
Mailing address:
  • Phone: 805-582-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: