Provider Demographics
NPI:1467887604
Name:FARAG, ASHLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FARAG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:COLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2900 TOWNSGATE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3001
Mailing Address - Country:US
Mailing Address - Phone:805-413-0360
Mailing Address - Fax:805-413-0361
Practice Address - Street 1:2900 TOWNSGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3001
Practice Address - Country:US
Practice Address - Phone:805-413-0360
Practice Address - Fax:805-413-0361
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13935103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst