Provider Demographics
NPI:1982879037
Name:HEATHCOTE, OLIVIA DENNIS (MFT)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:DENNIS
Last Name:HEATHCOTE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ELLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATES
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5221
Mailing Address - Country:US
Mailing Address - Phone:408-920-2990
Mailing Address - Fax:408-354-1504
Practice Address - Street 1:45 ELLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS GATES
Practice Address - State:CA
Practice Address - Zip Code:95030-5221
Practice Address - Country:US
Practice Address - Phone:408-920-2990
Practice Address - Fax:408-354-1504
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist