Provider Demographics
NPI:1336345032
Name:OLIVERA, LYNLEE A
Entity Type:Individual
Prefix:
First Name:LYNLEE
Middle Name:A
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNLEE
Other - Middle Name:A
Other - Last Name:SWEETLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 PARK VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1249
Mailing Address - Country:US
Mailing Address - Phone:805-464-6360
Mailing Address - Fax:805-762-4444
Practice Address - Street 1:1540 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2936
Practice Address - Country:US
Practice Address - Phone:805-464-6360
Practice Address - Fax:805-762-4444
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist