MEDICARE: MS. SHEIDA ASHLEY MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC34179	CA

General Provider Information

NPI Number	:	1376706473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEIDA ASHLEY MFT

Provider Business Mailing Address
First Line	:	2215 BENECIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2511
Country	:	US
Telephone Number	:	310-277-6362
Fax Number	:	310-552-0904

Provider Business Practice Location Address
First Line	:	2215 BENECIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2511
Country	:	US
Telephone Number	:	310-277-6362
Fax Number	:	310-552-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	05/19/2009

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