Provider Demographics
NPI:1467581256
Name:AYVAZIAN, ANNA JANNELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JANNELLE
Last Name:AYVAZIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20300 VENTURA BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0904
Mailing Address - Country:US
Mailing Address - Phone:818-900-4349
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD STE 330
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0904
Practice Address - Country:US
Practice Address - Phone:818-900-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health