Provider Demographics
NPI:1568580777
Name:LABISTOUR, ASHLEY COLLEEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:COLLEEN
Last Name:LABISTOUR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-923-5161
Mailing Address - Fax:
Practice Address - Street 1:711 S NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1831
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:213-251-3673
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist