Healthcare Provider Details

I. General information

NPI: 1316300619
Provider Name (Legal Business Name): SARA BETH OLIVER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA BETH COLGAN

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE STE 300
TEMECULA CA
92590-2697
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5170
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax: 805-683-3027
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT131423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: