Provider Demographics
NPI:1639394919
Name:EHREN, AVIVA
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:
Last Name:EHREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 STATE ST # 423
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2662
Mailing Address - Country:US
Mailing Address - Phone:831-234-5947
Mailing Address - Fax:
Practice Address - Street 1:429 SAN ANTONIO ROAD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:831-234-5947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist