Basic Information
| Provider Information | |||||||||
| NPI: | 1225357353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVAS | ||||||||
| FirstName: | EDDIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9033 WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629429625 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9033 WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629429625 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CADAC#A4001407 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | IMF62396 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.