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General NPI Number Information
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NPI Number | 1144533787
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Entity Type | Individual
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Provider Name | LYNDON R. OLMEDA LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/25/2010
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 322 W COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90220-3167
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Country | US
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Telephone | 310-639-8601
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Fax |
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Provider Business Mailing Address
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Address Line | 11550 E. MAIN STREET
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City | SANTA MARIA
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State | CA
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Zip | 93454
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Country | US
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Telephone | 424-362-4848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RA856608
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 26449
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License Number State | CA
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