Healthcare Provider Details

I. General information

NPI: 1922452291
Provider Name (Legal Business Name): ASHLEY WIRE MAZIASZ MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SHERMAN WAY STE 165
VAN NUYS CA
91406-3733
US

IV. Provider business mailing address

3441 COUNTRY HAVEN CIR
THOUSAND OAKS CA
91362-4964
US

V. Phone/Fax

Practice location:
  • Phone: 818-386-1094
  • Fax: 818-386-1182
Mailing address:
  • Phone: 805-573-3239
  • Fax: 818-386-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: