Provider Demographics
NPI:1083896013
Name:AYRES, JUSTIN BRET (LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BRET
Last Name:AYRES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W 6TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2694
Mailing Address - Country:US
Mailing Address - Phone:310-435-1246
Mailing Address - Fax:310-833-5672
Practice Address - Street 1:461 W 6TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2694
Practice Address - Country:US
Practice Address - Phone:310-435-1246
Practice Address - Fax:310-833-5672
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist