Provider Demographics
NPI:1164614285
Name:MOURA-THAKKAR, OLIVIA MANOPELLI (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:MANOPELLI
Last Name:MOURA-THAKKAR
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 BLUE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3521
Mailing Address - Country:US
Mailing Address - Phone:586-945-0766
Mailing Address - Fax:
Practice Address - Street 1:3304 BLUE RIDGE CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3521
Practice Address - Country:US
Practice Address - Phone:586-945-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013091103TC0700X
CAPSY31049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical