Provider Demographics
NPI:1144795014
Name:OLIVO, YVONNE LEEANN
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:LEEANN
Last Name:OLIVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:LEEANN
Other - Last Name:ABARCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3272 N WHIRLWIND AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6128
Mailing Address - Country:US
Mailing Address - Phone:559-901-0643
Mailing Address - Fax:
Practice Address - Street 1:197 E HAMILTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0261
Practice Address - Country:US
Practice Address - Phone:559-901-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2023-03-13
Deactivation Date:2019-06-04
Deactivation Code:
Reactivation Date:2019-06-27
Provider Licenses
StateLicense IDTaxonomies
CA95909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist