Provider Demographics
NPI:1982212809
Name:OLSON, KAITLIN KELLEY (AMFT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:KELLEY
Last Name:OLSON
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 1:260 MAPLE CT STE 265
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3572
Mailing Address - Country:US
Mailing Address - Phone:805-625-2244
Mailing Address - Fax:844-528-1796
Practice Address - Street 1:260 MAPLE CT STE 265
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3572
Practice Address - Country:US
Practice Address - Phone:805-625-2244
Practice Address - Fax:844-528-1796
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist