Provider Demographics
NPI:1275081002
Name:EID, ASHLEY LAUREN ELLIS
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAUREN ELLIS
Last Name:EID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2531 1/2 THAMES ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1606
Mailing Address - Country:US
Mailing Address - Phone:626-644-7891
Mailing Address - Fax:
Practice Address - Street 1:2531 1/2 THAMES ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1606
Practice Address - Country:US
Practice Address - Phone:626-644-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist