Healthcare Provider Details

I. General information

NPI: 1245772425
Provider Name (Legal Business Name): OPTIMAL INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 11/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MILLER ST STE 112
SANTA MARIA CA
93454-5243
US

IV. Provider business mailing address

PO BOX 6574
SANTA MARIA CA
93456-6574
US

V. Phone/Fax

Practice location:
  • Phone: 805-202-9335
  • Fax:
Mailing address:
  • Phone: 805-202-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT82011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT8963
License Number StateCA

VIII. Authorized Official

Name: OLE VON FRAUSING-BORCH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSED, RN, LMFT
Phone: 805-202-9335