Healthcare Provider Details

I. General information

NPI: 1164614285
Provider Name (Legal Business Name): OLIVIA MANOPELLI MOURA-THAKKAR PSY.D., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 BLUE RIDGE CT
WESTLAKE VILLAGE CA
91362-3521
US

IV. Provider business mailing address

3304 BLUE RIDGE CT
WESTLAKE VILLAGE CA
91362-3521
US

V. Phone/Fax

Practice location:
  • Phone: 586-945-0766
  • Fax:
Mailing address:
  • Phone: 586-945-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY31049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: