Healthcare Provider Details

I. General information

NPI: 1376543363
Provider Name (Legal Business Name): SALLY ANN OLSHAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2005
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30423 CANWOOD ST
AGOURA HILLS CA
91301-4317
US

IV. Provider business mailing address

5751 INGRAM PL
WESTLAKE VILLAGE CA
91362-5472
US

V. Phone/Fax

Practice location:
  • Phone: 818-865-8701
  • Fax: 818-991-4341
Mailing address:
  • Phone: 818-865-8701
  • Fax: 818-991-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 24071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: