Provider Demographics
NPI:1649932039
Name:OLESON, AVA K (LMFT)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:K
Last Name:OLESON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:K
Other - Last Name:OLESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED
Mailing Address - Street 1:417 SUNFLOWER
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8452
Mailing Address - Country:US
Mailing Address - Phone:417-597-2339
Mailing Address - Fax:
Practice Address - Street 1:417 SUNFLOWER
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8452
Practice Address - Country:US
Practice Address - Phone:417-597-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist