Provider Demographics
NPI:1194045971
Name:OLVERA, LAUREL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5050
Mailing Address - Country:US
Mailing Address - Phone:805-391-7001
Mailing Address - Fax:805-221-6023
Practice Address - Street 1:3528 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2531
Practice Address - Country:US
Practice Address - Phone:805-391-7001
Practice Address - Fax:805-221-6023
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-29517103T00000X, 103TC2200X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy