Provider Demographics
NPI:1881984722
Name:OLLIVIER, KATHLEEN ESTELLE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ESTELLE
Last Name:OLLIVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32094 VIA BUENA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3823
Mailing Address - Country:US
Mailing Address - Phone:949-240-8490
Mailing Address - Fax:
Practice Address - Street 1:16269 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3603
Practice Address - Country:US
Practice Address - Phone:949-788-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist