Healthcare Provider Details

I. General information

NPI: 1962998831
Provider Name (Legal Business Name): ALEXANDRIA NICOLE OLOSUNDE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

IV. Provider business mailing address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-2800
  • Fax: 530-887-2849
Mailing address:
  • Phone: 419-705-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberF.2200255
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: