Provider Demographics
NPI:1801179551
Name:ISHTIAQ, AISHA (LMFT)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:ISHTIAQ
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 1:1818 W BEVERLY BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3968
Mailing Address - Country:US
Mailing Address - Phone:213-973-3327
Mailing Address - Fax:
Practice Address - Street 1:1818 W BEVERLY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3968
Practice Address - Country:US
Practice Address - Phone:213-973-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104824106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator