Provider Demographics
NPI:1952046187
Name:OLIVO FAMILY THERAPY
Entity Type:Organization
Organization Name:OLIVO FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-901-0643
Mailing Address - Street 1:5045 N ROSEPOINT WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0903
Mailing Address - Country:US
Mailing Address - Phone:559-901-0643
Mailing Address - Fax:
Practice Address - Street 1:197 E HAMILTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0261
Practice Address - Country:US
Practice Address - Phone:559-901-0643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty