Provider Demographics
NPI:1851741136
Name:AMADOR, OLGA LYDIA (LMFT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:LYDIA
Last Name:AMADOR
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 1:1973 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3537
Mailing Address - Country:US
Mailing Address - Phone:909-276-7592
Mailing Address - Fax:909-755-0024
Practice Address - Street 1:1338 CENTER COURT DR STE 105
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3681
Practice Address - Country:US
Practice Address - Phone:909-276-7592
Practice Address - Fax:909-755-0024
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF101126101YM0800X
106H00000X
CA114497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health