Provider Demographics
NPI:1225357353
Name:OLIVAS, EDDIE III (MFTI)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:
Last Name:OLIVAS
Suffix:III
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3839
Mailing Address - Country:US
Mailing Address - Phone:562-942-9625
Mailing Address - Fax:
Practice Address - Street 1:9033 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3839
Practice Address - Country:US
Practice Address - Phone:562-942-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADAC#A4001407101YA0400X
CAIMF62396106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)