Provider Demographics
NPI:1124408018
Name:AZIN, ASHLEY (MA, MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:AZIN
Suffix:
Gender:F
Credentials:MA, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 W SAN MARCOS BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4081
Mailing Address - Country:US
Mailing Address - Phone:858-663-9004
Mailing Address - Fax:
Practice Address - Street 1:1582 W SAN MARCOS BLVD
Practice Address - Street 2:STE 105
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:858-663-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist