Active NPI
Timothy M Olson, MFT
- Marriage & Family Therapist
- Lake Elsinore, CA
National Provider Identifier
1780910786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 52764
- Practice address
- 31681 Riverside Dr
Suite L
Lake Elsinore, CA 92530-7815 - Phone
- (808) 391-3595
- Fax
- (951) 463-4043
- NPI assigned
- Oct 26, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 52764 | CA | Primary |
Addresses
Primary practice location
31681 Riverside Dr
Suite L
Lake Elsinore, CA 92530-7815
Mailing address
1451 Rimpau Ave
Suite 212
Corona, CA 92879-7520
Phone (808) 391-3595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52764 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486166400000",
"number": "1780910786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1451 RIMPAU AVE",
"address_2": "SUITE 212",
"city": "CORONA",
"state": "CA",
"postal_code": "928797520",
"telephone_number": "808-391-3595",
"fax_number": "951-463-4043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31681 RIVERSIDE DR",
"address_2": "SUITE L",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925307815",
"telephone_number": "808-391-3595",
"fax_number": "951-463-4043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "TIMOTHY",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-26",
"last_updated": "2017-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "52764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.