Healthcare Provider Details

I. General information

NPI: 1346583143
Provider Name (Legal Business Name): LIRIO OHLSON M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 N SANTA CRUZ AVE SUITE L
LOS GATOS CA
95030-5931
US

IV. Provider business mailing address

PO BOX 1384
CAMPBELL CA
95009-1384
US

V. Phone/Fax

Practice location:
  • Phone: 408-836-3514
  • Fax:
Mailing address:
  • Phone: 408-836-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: