Healthcare Provider Details

I. General information

NPI: 1548081276
Provider Name (Legal Business Name): EFREN OLMOS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31194 LA BAYA DR STE 102
WESTLAKE VILLAGE CA
91362-4022
US

IV. Provider business mailing address

6434 KENWATER AVE
WEST HILLS CA
91307-3128
US

V. Phone/Fax

Practice location:
  • Phone: 818-307-3251
  • Fax:
Mailing address:
  • Phone: 818-588-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: