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Desiree D Ohlstrom

Marriage & Family Therapist

Behavioral Health & Social Service Providers

2350 Professional Dr, Santa Rosa, CA 95403-3018

PECOS Enrollment

This provider is enrolled in PECOS as DESIREE OHLSTROM.

Based on the most recent information from CMS, provider Desiree D Ohlstrom is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1659670503
Provider Type
Individual
Full Name
Ohlstrom, Desiree D
Title
Mrs.
Credential
LMFT

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/17/2011
Last Updated
2/6/2015

Contact Information

Practice Location

2350 Professional Dr, Santa Rosa, CA 95403-3018

(707) 565-4963

Unlisted Fax

Mailing Location

2350 Professional Dr, Santa Rosa, CA 95403-3018

(707) 565-4963

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106H00000X Primary	Description Marriage & Family Therapist Behavioral Health & Social Service Providers	License LMFT85031 California

Desiree D Ohlstrom

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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