Provider Demographics
NPI:1154449171
Name:ROSE, AYANA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:AYANA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 VAN NUYS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1338
Mailing Address - Country:US
Mailing Address - Phone:818-896-2255
Mailing Address - Fax:818-899-7293
Practice Address - Street 1:12510 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1338
Practice Address - Country:US
Practice Address - Phone:626-896-2255
Practice Address - Fax:818-899-7293
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist