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NPI Code Detail

MEDICARE: SHELBY ASH PSYD

MEDICARE: SHELBY ASH PSYD
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
1101YM0800XMental Health CounselorPSB94027235

General Provider Information

NPI Number : 1801672514
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY ASH PSYD
Provider Business Mailing Address
First Line : 1346 S CLOVERDALE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-2806
Country : US
Telephone Number : 310-902-7710
Fax Number :
Provider Business Practice Location Address
First Line : 3306 GLENDALE BLVD STE 7
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-1838
Country : US
Telephone Number : 323-207-5426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2023
Last Update Date : 09/07/2023

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Directions to “ SHELBY ASH PSYD” Practice Location

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