Provider Demographics
NPI:1346962198
Name:KOCA, AYSIN (AMFT)
Entity Type:Individual
Prefix:
First Name:AYSIN
Middle Name:
Last Name:KOCA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 SLEW OF GOLD CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2546
Mailing Address - Country:US
Mailing Address - Phone:951-940-4928
Mailing Address - Fax:
Practice Address - Street 1:2464 SLEW OF GOLD CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2546
Practice Address - Country:US
Practice Address - Phone:951-940-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty