Healthcare Provider Details

I. General information

NPI: 1235087149
Provider Name (Legal Business Name): LATREECE OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 11TH AVE
LOS ANGELES CA
90043-4847
US

IV. Provider business mailing address

11072 EXCELSIOR DR APT 6W
NORWALK CA
90650-5600
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-5058
  • Fax:
Mailing address:
  • Phone: 323-290-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: