Provider Demographics
NPI:1568021152
Name:OLMSTED, OLIVIA CARMEN (AMFT)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:CARMEN
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 STAGE GULCH RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-9541
Mailing Address - Country:US
Mailing Address - Phone:206-390-8520
Mailing Address - Fax:
Practice Address - Street 1:3650 STANDISH AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-8113
Practice Address - Country:US
Practice Address - Phone:707-234-5092
Practice Address - Fax:707-585-6155
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT95201OtherBOARD OF BEHAVIORAL SCIENCES