Provider Demographics
NPI:1871191288
Name:TUGWELL, OLIVIA M
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:TUGWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 TARRYTOWN CT
Mailing Address - Street 2:
Mailing Address - City:UNITED STATES
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4022
Mailing Address - Country:US
Mailing Address - Phone:925-876-9674
Mailing Address - Fax:
Practice Address - Street 1:628 TARRYTOWN CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-4022
Practice Address - Country:US
Practice Address - Phone:925-876-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician