Healthcare Provider Details

I. General information

NPI: 1508346883
Provider Name (Legal Business Name): ELIZABETH OLLEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 01/28/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD STE 740
LOS ANGELES CA
90025-7082
US

IV. Provider business mailing address

1849 SAWTELLE BLVD STE 740
LOS ANGELES CA
90025-7082
US

V. Phone/Fax

Practice location:
  • Phone: 424-442-0112
  • Fax:
Mailing address:
  • Phone: 424-442-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY31077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: