Provider Demographics
NPI:1295139772
Name:OLIVER, JERI (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0562
Mailing Address - Country:US
Mailing Address - Phone:424-262-2536
Mailing Address - Fax:
Practice Address - Street 1:1050 DUNCAN AVE
Practice Address - Street 2:SUITE J
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6700
Practice Address - Country:US
Practice Address - Phone:424-262-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist