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General NPI Number Information
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NPI Number | 1912447103
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Entity Type | Individual
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Provider Name | AYAZ HUSAIN LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 14119 RUNNYMEDE ST
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City | VAN NUYS
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State | CA
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Zip | 91405-1433
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Country | US
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Telephone | 484-223-6143
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Fax |
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Provider Business Mailing Address
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Address Line | 14119 RUNNYMEDE ST
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City | VAN NUYS
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State | CA
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Zip | 91405-1433
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Country | US
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Telephone | 484-223-6143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CTB-2024-0765
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License Number State | NM
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