Provider Demographics
NPI:1578344099
Name:PARIS, CHANELL ASHLEY (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:CHANELL
Middle Name:ASHLEY
Last Name:PARIS
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:CHANELL
Other - Middle Name:ASHLEY CANONO
Other - Last Name:PARIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 N 3RD ST # 130
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1202
Mailing Address - Country:US
Mailing Address - Phone:562-659-9633
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-5017
Practice Address - Country:US
Practice Address - Phone:800-700-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14620101YP2500X
CAAMFT141275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional