Provider Demographics
NPI:1346583143
Name:OHLSON, LIRIO (MA, MFT)
Entity Type:Individual
Prefix:
First Name:LIRIO
Middle Name:
Last Name:OHLSON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95009-1384
Mailing Address - Country:US
Mailing Address - Phone:408-836-3514
Mailing Address - Fax:
Practice Address - Street 1:59 N SANTA CRUZ AVE
Practice Address - Street 2:SUITE L
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5931
Practice Address - Country:US
Practice Address - Phone:408-836-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist