Provider Demographics
NPI:1518090042
Name:JAHNSEN, OLIVE ELLA (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:ELLA
Last Name:JAHNSEN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MRS
Other - First Name:OLLIE
Other - Middle Name:ELLA
Other - Last Name:JAHNSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:2758 STATE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7910
Mailing Address - Country:US
Mailing Address - Phone:530-743-1104
Mailing Address - Fax:
Practice Address - Street 1:1130 CONROY LN STE 500
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4153
Practice Address - Country:US
Practice Address - Phone:916-784-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist