Provider Demographics
NPI:1114677622
Name:KALISHER, AYALA (AMFT 131731)
Entity Type:Individual
Prefix:
First Name:AYALA
Middle Name:
Last Name:KALISHER
Suffix:
Gender:F
Credentials:AMFT 131731
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1553
Mailing Address - Country:US
Mailing Address - Phone:530-220-4047
Mailing Address - Fax:
Practice Address - Street 1:803 ALVARADO RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1553
Practice Address - Country:US
Practice Address - Phone:530-220-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health