Provider Demographics
NPI:1528727161
Name:OLSON, DENISE RUTH (LMFT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:RUTH
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 LONE TREE WAY # 4-202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5370
Mailing Address - Country:US
Mailing Address - Phone:925-337-3211
Mailing Address - Fax:
Practice Address - Street 1:1649 LILLIAN ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5258
Practice Address - Country:US
Practice Address - Phone:925-337-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist