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General NPI Number Information
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NPI Number | 1578232682
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Entity Type | Individual
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Provider Name | MR. JONATHAN TREVOR OLEVSON
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Gender | Male
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1680 N FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91103-1642
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Country | US
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Telephone | 626-789-0884
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 N GOWER ST APT 301
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City | LOS ANGELES
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State | CA
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Zip | 90028-6457
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Country | US
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Telephone | 323-683-5917
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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 | B00003751224
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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