Healthcare Provider Details

I. General information

NPI: 1245951946
Provider Name (Legal Business Name): JACQUELINE OLAZABA AMFT AND APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 E. HUNTINGTON DR.
DUARTE CA
91010
US

IV. Provider business mailing address

2502 E. HUNTINGTON DR.
DUARTE CA
91010
US

V. Phone/Fax

Practice location:
  • Phone: 626-263-9133
  • Fax:
Mailing address:
  • Phone: 626-263-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC11947
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT133998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: