Provider Demographics
NPI:1659670503
Name:OHLSTROM, DESIREE D (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:D
Last Name:OHLSTROM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3018
Mailing Address - Country:US
Mailing Address - Phone:707-565-4963
Mailing Address - Fax:
Practice Address - Street 1:2350 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3018
Practice Address - Country:US
Practice Address - Phone:707-565-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT85031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist