Provider Demographics
NPI:1245772425
Name:OPTIMAL INTERVENTIONS
Entity Type:Organization
Organization Name:OPTIMAL INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON FRAUSING-BORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, RN, LMFT
Authorized Official - Phone:805-202-9335
Mailing Address - Street 1:PO BOX 6574
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-6574
Mailing Address - Country:US
Mailing Address - Phone:805-202-9335
Mailing Address - Fax:
Practice Address - Street 1:301 S MILLER ST STE 112
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5243
Practice Address - Country:US
Practice Address - Phone:805-202-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT8963106H00000X
CALMFT82011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty