Provider Demographics
NPI:1760813372
Name:MOZART, ASHLEY (MA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOZART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 GLENNEYRE ST
Mailing Address - Street 2:#56
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3103
Mailing Address - Country:US
Mailing Address - Phone:714-494-9484
Mailing Address - Fax:
Practice Address - Street 1:30220 RANCHO VIEJO RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1568
Practice Address - Country:US
Practice Address - Phone:714-494-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48524106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist