Provider Demographics
NPI:1275150534
Name:ELLINGHAM, JAAYDA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JAAYDA
Middle Name:
Last Name:ELLINGHAM
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 GALENA AVE # 1053
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1305
Mailing Address - Country:US
Mailing Address - Phone:818-481-6025
Mailing Address - Fax:
Practice Address - Street 1:2551 GALENA AVE # 1053
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1305
Practice Address - Country:US
Practice Address - Phone:818-481-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist