Provider Demographics
NPI:1588199525
Name:SHARIS AYAZJOO, MFT, MARRIAGE & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:SHARIS AYAZJOO, MFT, MARRIAGE & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AYAZJOO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MS
Authorized Official - Phone:818-726-6738
Mailing Address - Street 1:3030 EMERALD ISLE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1010
Mailing Address - Country:US
Mailing Address - Phone:818-726-6738
Mailing Address - Fax:
Practice Address - Street 1:18425 BURBANK BLVD
Practice Address - Street 2:SUITE #613
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2806
Practice Address - Country:US
Practice Address - Phone:818-726-6738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty